胸水M1/M2型巨噬细胞比例在结核性胸膜炎与恶性胸腔积液鉴别中的价值

Clinical value of macrophage M1/M2 ratio in differentiating tuberculous pleurisy from malignant pleural effusion

目的探讨巨噬细胞极化在结核性胸膜炎与恶性胸腔积液鉴别中的价值。方法前瞻性收集2018年10月至2019年9月到我院就诊的新发结核性胸膜炎或恶性胸腔积液患者,在治疗前采集胸腔积液与外周血,流式细胞术检测M1型(CD14^+CD86^+)与M2型(CD14^+CD163^+)单核巨噬细胞。并测定外周血细胞计数、血沉、γ-干扰素释放试验及胸腔积液腺苷脱氨酶。结果纳入结核组51例,肿瘤组39例。结核组外周血CD14^+巨噬细胞高于肿瘤组,胸水M1型巨噬细胞高于肿瘤组,M2型巨噬细胞低于肿瘤组(P<0.05)。胸水M1/M2>0.92诊断结核性胸膜炎的敏感性86.3%,特异性94.6%,阳性预测值86.3%,阴性预测值81.7%(曲线下面积0.946)。结论结核性胸水中巨噬细胞向M1极化,恶性胸水巨噬细胞向M2极化,胸水M1/M2>0.92可作为结核性胸膜炎与恶性胸水鉴别的免疫学指标。

Objective To compare the number and proportion of macrophages M1 and M2 in pleural effusion and peripheral blood in patients with tuberculous pleurisy and malignant pleural effusion,and to evaluate the value of differential diagnosis.Methods Patients with tuberculous pleurisy or malignant pleural effusion admitted to our hospital from October 2018 to September 2019 were prospectively recruited.Pleural fluid and peripheral blood samples were obtained before treatment for macrophage phenotype(M1:CD14^+CD86^+;M2:CD14^+CD163^+).Meanwhile,peripheral blood cell count,erythrocyte sedimentation rate,interferon-γrelease test and adenosine deaminase in pleural effusion were detected.Results CD14^+monocyte in peripheral blood of the tuberculosis group were higher than those in the tumor group,M1 macrophages in pleural fluid of the tuberculosis group were higher than those in the tumor group,and M2 macrophages were lower than those in the tumor group(P<0.05).On receiver operating characteristic(ROC)curve analysis,the optimal cut-off level of M1/M2 ratio for differentiating tuberculous pleurisy from malignant pleural effusion was 0.92(area under the curve:0.946;sensitivity:86.3%;specificity:94.6%;positive predictive value:86.3%;negative predictive value:81.7%).Conclusion Macrophages polarize to M1 phenotype in tuberculous pleurisy and M2 phenotype in malignant pleural effusion.The ratio of M1 to M2 more than 0.92 can be used as an immunological indicator for the differentiating tuberculous pleurisy from malignant pleural effusion.