早期炎症细胞因子对肺结核患者预后的预测作用

The predictive effect of early inflammatory cytokines on the prognosis of patients with pulmonary tuberculosis

目的 探讨肺结核患者在抗结核治疗早期炎症细胞因子水平对其治疗结束后继发慢性疾病的预测作用。方法 依托2013年5月—2015年8月连续纳入的活动性肺结核患者治疗队列,于2019和2020年进行电话随访。用双抗体夹心ELISA法检测治疗前、治疗2个月末细胞因子IFN-γ、IL-2、IL-4以及IL-10的水平及变化特点。结果根据随访结果分为继发慢性病组(n=27)和健康状态组(n=122),分析发现,两组人群接受抗结核治疗后IL-2较治疗前明显下降,IL-10水平却有所上升,治疗前后差异显著(P<0.05)。两组人群的IFN-γ、IL-4水平在治疗前后未表现出显著差异(P>0.05)。多因素Logistic回归分析显示,治疗前IFN-γ越低(OR=0.980,95%CI:0.964~0.996,P=0.016)、IL-10越高(OR=1.015,95%CI:1.002~1.029,P=0.026),患者继发其他慢性病的可能性就越高。治疗前IFN-γ和IL-10联合预测慢性病发生风险的AUC为0.67(95%CI:0.56-0.78)。结论 治疗前IFN-γ降低伴IL-10升高对结核病患者继发其他慢性疾病具有一定的预测价值。

Objective To explore the role of inflammatory cytokine levels in patients with pulmonary tuberculosis in the early stage of anti-tuberculosis treatment in predicting the risk of secondary chronic diseases after the complement of treatment. Methods Telephone follow-up of active pulmonary tuberculosis patients cohort enrolled from May 2013 to Aug 2015 were carried out in 2019 and 2020.The double-antibody sandwich ELISA method was used to detect the levels and change characteristics of cytokines IFN-γ,IL-2,IL-4 and IL-10 before treatment and at the end of two months of treatment.Results According to the follow-up results,patients were divided into secondary chronic disease group(n=27) and healthy state group(n=122). The analysis found that after the two groups received antituberculosis treatment,IL-2 was significantly lower than before treatment,while IL-10 levels increased,which showed a significant difference between before and after treatment(P<0.05).The levels of IFN-γand IL-4 between the two groups did not show significant differences before and after treatment(P>0.05).Multivariate Logistic regression analysis showed that the lower the IFN-γ before treatment(OR=0.980,95%CI:0.964-0.996,P=0.016),the higher the IL-10(OR=1.015,95%CI:1.002-1.029,P=0.026),the higher the possibility of patients developing other chronic diseases.The AUC of the risk of chronic disease predicted by baseline IFN-γ and IL-10 was 0.67(95CI% :0.56-0.78). Conclusion The reduction of IFN-γ and the increase of IL-10 before treatment has certain predictive value of other secondary chronic diseases for tuberculosis patients.