多发性骨髓瘤患者化疗后感染病原菌及Th17/Treg与细胞因子

Analysis of pathogenic characteristics and change of helper T lymphocyte/ regulatory T lymphocyte and cytokines in patients with multiple myeloma after chemotherapy

目的探讨多发性骨髓瘤患者化疗后感染病原菌及辅助型T淋巴细胞/调节性T淋巴细胞(Th17/Treg)与细胞因子。方法选择核工业四一六医院血液风湿科2016年3月-2019年9月收治的多发性骨髓瘤化疗后感染患者60例作为感染组,选择同期收治的多发性骨髓瘤化疗后未感染患者40例纳入未感染组。对感染组患者感染部位及病原菌进行分析,检测两组患者外周血Th17/Treg、白细胞介素-17(IL-17)、IL-23、干扰素-γ(IFN-γ),对感染组不同分期患者Th17、Treg、Th17/Treg、IL-17、IL-23、IFN-γ水平进行比较。结果多发性骨髓瘤患者化疗后以呼吸道感染为主(71.67%);共培养分离病原菌10株,其中革兰阴性菌4株,革兰阳性菌2株,真菌(白假丝酵母)4株;感染组Th17、Th17/Treg、IL-17、IL-23分别为(2.09±0.61)%、1.77±0.29、(83.81±24.25)pg/ml、(43.51±16.34)pg/ml高于未感染组,Treg、IFN-γ分别为(1.18±0.35)%、(20.81±8.94)pg/ml低于未感染组(P<0.05);三组患者Th17、Treg、Th17/Treg、IL-17、IL-23、IFN-γ总体差异具有统计学意义(P<0.05),其中III期患者Th17、Th17/Treg、IL-17、IL-23分别为(2.41±0.31)%、(2.56±0.23)、(89.86±17.28)pg/ml、(47.61±12.19)pg/ml高于I期及II期患者,Treg、IFN-γ分别为(0.94±0.18)%、(14.29±4.97)pg/ml低于I期及II期患者(P<0.05);II期患者Th17、Th17/Treg、IL-17、IL-23高于I期患者,Treg、IFN-γ则低于I期患者(P<0.05)。结论多发性骨髓瘤患者化疗后以呼吸道感染居多,病原菌总体分布松散,且随临床分期增加Th17/Treg的失衡也逐渐严重,临床应加强病原培养及针对性用药。

OBJECTIVE To investigate the pathogenic characteristics and the changes of helper T lymphocyte/regulatory T lymphocyte(T17/Treg) and cytokines changes in patients with multiple myeloma after chemotherapy. METHODS Sixty patients with multiple myeloma who were infected after chemotherapy admitted to the Department of Hematology and Rheumatology of Nuclear Industry 416 Hospital from Mar. 2016 to Sep. 2019 were selected as the infection group, and 40 patients with multiple myeloma who were not infected after chemotherapy admitted at the same time were selected into the non-infected group. The infection site and pathogenic bacteria of the infected group were analyzed, and the peripheral blood Th17/Treg, interleukin-17(IL-17), IL-23, and interferon-γ(IFN-γ) were detected in the two groups. The levels of Th17, Treg, Th17/Treg, IL-17, IL-23, and IFN-γ of patients in different stages of the infection group were compared. RESULTS Respiratory tract infections were the main cause of multiple myeloma after chemotherapy(71.67%);10 strains of pathogenic bacteria were co-cultured and isolated, including 4 strains of gram-negative bacteria, 2 strains of gram-positive bacteria, and 4 strains of fungi(Candida albicans). Th17, Th17/Treg, IL-17 and IL-23 in the infected group were(2.09±0.61)%, 1.77±0.29,(83.81±24.25)pg/ml, and(43.51±16.34)pg/ml, respectively, significantly higher than those in the non-infected group, Treg and IFN-γ were(1.18±0.35)% and(20.81±8.94)pg/ml, respectively, significantly lower than those of the non-infected group(P<0.05);the overall differences of Th17, Treg, Th17/Treg, IL-17, IL-23, IFN-γ in the three groups of patients were significant(P<0.05). Th17, Th17/Treg, IL-17, and IL-23 of stage III patients were(2.41±0.31)%,(2.56±0.23),(89.86±17.28)pg/ml, and(47.61±12.19)pg/ml, respectively, significantly higher than those in stage I and II patients, Treg and IFN-γ were(0.94±0.18)% and(14.29±4.97)pg/ml, respectively, significantly lower than those in stage I and II patients(P<0.05);Th17, Th17/Treg IL-17, and IL-23 of stage II patients were significantly higher than those in stage I patients, Treg and IFN-γ were lower than those in stage I patients(P<0.05). CONCLUSION Patients with multiple myeloma had more respiratory tract infections after chemotherapy, and the overall distribution of pathogens was loose. The imbalance of Th17/Treg was gradually serious with the increase clinical stages. Doctors should strengthen pathogen culture and targeted medication.