Th1、Th2、Th17细胞因子水平在耐多药结核病患者外周血中的变化及预后不良危险因素分析

Changes of Th1,Th2 and Th17 cytokines in peripheral blood of patients with multidrug resistant tuberculosis and analysis of risk factors in poor prognosis

目的探讨辅助性T细胞(Th)1、Th2、Th17细胞因子水平在耐多药结核病(MDR-TB)患者外周血中的变化,并分析预后不良的危险因素。方法收集2018年1月-2021年1月芜湖市第五人民医院及芜湖市第三人民医院收治的178例MDR-TB患者的临床资料,将其作为MDR-TB组;选取同期85例非MDR-TB患者为NMDR-TB组,85例健康志愿者为对照组。比较3组患者Th1细胞因子[干扰素γ(IFN-γ)、白细胞介素(IL)-2]、Th2细胞因子(IL-4、IL-5)及Th17细胞因子(IL-17)水平;按照MDR-TB组治疗效果分为预后良好、预后不良,比较预后良好患者与预后不良患者临床资料的差异,并采用多因素Logistic回归分析探讨预后不良影响因素;建立受试者工作特征曲线(ROC),分析Th1、Th2、Th17细胞因子检测对MDR-TB诊断价值。结果与对照组相比,NMDR TB组、MDR-TB组IFN-γ、IL-4、IL-17水平降低,且MDR-TB组低于NMDR-TB组(P<0.05)。MDR-TB组预后不良20例(11.24%),其中预后良好与预后不良患者的平均年龄、病程、合并肺部感染情况及IFN-γ、IL-4、IL-17水平差异有统计学意义(P<0.05);多因素Logistic回归分析显示,年龄、IFN-γ、IL-4、IL-17为MDR-TB预后不良影响因素(P<0.05);ROC曲线显示,IFN-γ、IL-4、IL-17水平联合检测对MDR-TB的诊断价值较高,灵敏度88.76%,特异度87.06%,曲线下面积(AUC)为0.811。结论MDR-TB患者Th1、Th2细胞因子IFN-γ、IL-4及Th17细胞因子IL-17水平降低,IFN-γ、IL-4、IL-17水平联合检测对MDR-TB诊断价值较高,且IFN-γ、IL-4、IL-17水平是MDR-TB患者预后不良的影响因素。

Objective To investigate the changes of T helper cell(Th)1,Th2 and Th17 cytokines in peripheral blood of patients with multi drug resistant tuberculosis(MDR-TB)to analyze the risk factors in poor prognosis.Method The clinical data of 178 patients with MDR-TB treated in Wuhu Fifth People's Hospital and Wuhu Third People's Hospi⁃tal from January 2018 to January 2021 were collected as MDR-TB group.In the same period,85 non-MDR-TB pa⁃tients and 85 healthy volunteers were selected as NMDR-TB group and the control group.The levels of Th1 cytokines[Interferonγ(IFN-γ),Interleukin(IL)-2],Th2 cytokines(IL-4,IL-5)and Th17 cytokines(IL-17)in 3 groups were compared.According to the treatment effect of MDR-TB group,the patients were divided into good prognosis and poor prognosis.The clinical data of the patients with good prognosis and poor prognosis were compared,and the influencing factors of poor prognosis were discussed by multivariate logistic regression analysis.The receiver operating characteris⁃tic curve(ROC)was established to analyze the value of Th1,Th2 and Th17 cytokines in detection of MDR-TB.Result Compared with the control group,the levels of IFN-γ,IL-4 and IL-17 in NMDR-TB group and MDR-TB group were decreased,and MDR-TB group lower than NMDR-TB group(P<0.05).Twenty cases(11.24%)in the MDR-TB group had a poor prognosis.There were significant differences in age,course of disease,pulmonary infection and levels of IFN-γ,IL-4 and IL-17 between the patients with good and poor prognosis(P<0.05).Multivariate logistic regression analysis showed that age,IFN-γ,IL-4 and IL-17 were risk factors for poor prognosis of MDR-TB(P<0.05).ROC curve showed that joint detection of IFN-γ,IL-4 and IL-17 were more valuable in detecting MDR-TB;the sensitivity was 88.76%;the specificity was 87.06%,and the area under curve roc(AUC)was 0.811.Conclusion The levels of IFN-γand IL-4 of Th1 and Th2 cytokines and the levels of IL-17 of Th17 cytokines in MDR-TB patients were de⁃creased;IFN-γ,IL-4 and IL-17 Joint detection had high diagnostic value for MDR-TB,and the levels of IFN-γ,IL 4 and IL-17 are the prognostic factors of MDR-TB patients treated with moxifloxacin.