细菌性肺炎患者外周血Th1/Th2细胞因子水平变化及临床意义

Changes in Peripheral Blood Th1/Th2 Cytokine Levels and Clinical Significance in Patients with Bacterial Pneumonia

目的:探究细菌性肺炎患者外周血辅助性T细胞1/辅助性T细胞2(Th1/Th2)细胞因子水平变化情况及临床意义。方法:将2018年1月至2021年1月期间于我院就诊的123例细菌性肺炎患者作为研究对象,采用CURB-65评分系统评估病情严重程度,将其分为中重度组(CURB-65评分≥2分)72例和轻度组(CURB-65评分0~1分)51例。比较两组基线资料、Th1/Th2及Th1/Th2分泌细胞因子[干扰素-γ(IFN-γ)、白细胞介素-4(IL-4)],分析细菌性肺炎患者Th1/Th2、IFN-γ、IL-4水平与其CURB-65评分的相关性,绘制受试者工作特征(ROC)曲线分析上述指标对中重度细菌性肺炎的诊断效能。结果:两组性别、年龄、吸烟史、合并症等基线资料均无显著差异(P>0.05),中重度组白细胞计数(WBC)、降钙素原(PCT)水平显著高于轻度组(P<0.05);中重度组Th1/Th2、IFN-γ水平均显著低于轻度组(P<0.05),IL-4显著高于轻度组(P<0.05);Spearman相关性分析表明,细菌性肺炎患者CURB-65评分与Th1/Th2、IFN-γ呈显著负相关(P<0.05),与IL-4呈显著正相关(P<0.05);ROC曲线分析显示,上述指标诊断中重度细菌性肺炎的AUC分别为0.904、0.886、0.818,截断值分别为2.42、9.34pg/m L、10.98pg/m L,三指标联合诊断AUC为0.985,具有较高的诊断效能(P<0.05)。结论:细菌性肺炎患者外周血Th1/Th2及其细胞因子水平与病情严重程度有关,该指标对于病情评估及治疗具有参考价值。

Objective:To explore the changes and clinical significance of levels of peripheral blood helper T cell 1/helper T cell 2(Th1/Th2)cytokines in patients with bacterial pneumonia.Methods:123 patients with bacterial pneumonia who were treated in the hospital between January 2018 and January 2021 were selected as the research subjects.CURB-65 scoring system was used to assess the severity of the disease,and the patients were divided into a moderate-to-severe group(CURB-65 score≥2 points,72 cases)and a mild group(CURB-65 score of 0-1 point,51 cases).The baseline data,Th1/Th2 and Th1/Th2 secretory cytokines[interferon-γ(IFN-γ),interleukin-4(IL-4)]were compared between the two groups,and the correlation between levels of Th1/Th2,IFN-γand IL-4 and CURB-65 score in patients with bacterial pneumonia,and receiver operating characteristic(ROC)curve was plotted to analyze the diagnostic efficiency of the above indicators on moderate-to-severe bacterial pneumonia.Results:There were no significant differences in gender,age,smoking history,comorbidities,and other baseline data between the two groups(P>0.05).The white blood cell count(WBC)and procalcitonin(PCT)levels in the moderate-to-severe group were significantly higher than those in the mild group(P<0.05).The levels of Th1/Th2 and IFN-γwere significantly lower in the moderate-to-severe group than those in the mild group(P<0.05)while the level of IL-4 was significantly higher than that in the mild group(P<0.05).Spearman correlation analysis showed that the CURB-65 score of patients with bacterial pneumonia was significantly negatively correlated with Th1/Th2 and IFN-γ(P<0.05),and was significantly positively correlated with IL-4(P<0.05).ROC curve analysis showed that the AUC values of the above indicators in diagnosing moderate-to-severe bacterial pneumonia were 0.904,0.886,and 0.818,and the cut-off values were 2.42,9.34 pg/ml,and 10.98 pg/ml,and the AUC of the combination of the three indicators was 0.985,with high diagnostic efficiency(P<0.05).Conclusion:The levels of Th1/Th2 and its cytokines in peripheral blood of patients with bacterial pneumonia are related to the severity of the disease.The above indicators have a reference value for the evaluation and treatment of the disease.