血清干扰素调节因子1对初治肺结核患者疗效的影响

Effect of serum interferon regulatory factor 1 on curative effect of newly treated patients with pulmonary tuberculosis

目的 探讨血清干扰素调节因子1(IRF-1)水平与初治肺结核患者T淋巴细胞免疫功能及近期疗效的关系。方法 2018年1月至2021年1月河南省胸科医院连续收治新诊断肺结核患者为研究对象。采用酶联免疫吸附法检测血清中IRF-1水平,根据IRF-1检测结果,将患者分为高IRF-1组和低IRF-1组。流式细胞术检测外周血中CD4^(+)、CD8^(+)、Th17和Treg细胞水平。所有患者均在规范治疗6个月后接受临床疗效评估,统计患者临床症状消失、痰涂片转阴、肺部浸润影消失和临床治愈情况。结果 高IRF-1组和低IRF-1组初治肺结核患者性别、年龄、户口、体质量指数、合并糖尿病和合并咯血情况比较,差异无统计学意义(P>0.05);高IRF-1组CD4^(+)、CD4^(+)/CD8^(+)、Treg低于低IRF-1组,CD8^(+)、Th17水平高于高IRF-1组,差异有统计学意义(t=6.359、6.129、4.881、3.692、4.800、5.829,P均<0.05);高IRF-1组规范抗结核治疗6个月后临床症状消失率、痰涂片转阴率和肺部浸润影消失率低于低IRF-1组,差异有统计学意义(χ^(2)=6.571、6.154、4.453,P均<0.05),但两组临床治愈率比较差异无统计学意义(χ^(2)=1.313,P>0.05)。ROC分析结果显示,开始治疗前IRF-1水平预测初治肺结核患者治疗6个月临床症状消失、痰涂片转阴和肺部浸润影消失曲线下面积分别为0.731、0.792和0.775,截断值分别为54.34、56.73和53.86。结论 血清IRF-1水平可反映初治肺结核患者T细胞免疫功能,且与患者规律治疗6个月临床疗效有一定关联。

Objective To investigate the relationship between serum interferon regulatory factor 1(IRF-1)level and T lymphocyte immune function and short-term efficacy in newly treated pulmonary tuberculosis patients. Methods From January 2018 to January 2021,patients with newly diagnosed pulmonary tuberculosis were consecutively admitted to the Henan Provincial Chest Hospital as the research object. The serum IRF-1 level was detected by enzyme-linked immunosorbent assay. According to the IRF-1 detection results,the patients were divided into high IRF-1 group and low IRF-1 group. The levels of CD4^(+),CD8^(+),Th17 and Treg cells in peripheral blood were detected by flow cytometry. All patients were evaluated for clinical efficacy after 6 months of standard treatment. The disappearance of clinical symptoms,negative sputum smear,disappearance of pulmonary infiltrates and clinical cure were counted. Results There was no significant difference in gender,age,household registration,body mass index,diabetes mellitus and hemoptysis in newly treated pulmonary tuberculosis patients with high IRF-1 group and low IRF-1 group(P>0.05). The levels of CD4^(+),CD4^(+)/CD8^(+)and Treg in the high IRF-1 group were lower than those in the low IRF-1 group,and the levels of CD8^(+)and Th17 were higher than those in the high IRF-1 group,and the differences were statistically significant(t=6.359,6.129,4.881,3.692,4.800,5.829,P<0.05). The disappearance rate of clinical symptoms,negative rate of sputum smear and pulmonary infiltrates after 6 months of standard anti-tuberculosis treatment in the high IRF-1 group were lower than those in the low IRF-1 group,with statistical differences(χ^(2)=6.571,6.154,4.453,P<0.05). There was no significant difference in the clinical cure rate between the two groups(χ^(2)=1.313,P>0.05). The results of ROC analysis showed that the IRF-1 level before the start of treatment predicted the disappearance of clinical symptoms,sputum smear negative and disappearance of pulmonary infiltrates in patients with pulmonary tuberculosis at 6 months of treatment. The areas under the curve were0.731,0.792 and 0.775,respectively. The cutoff values are 54.34,56.73 and 53.86,respectively. Conclusion The serum IRF-1 level can reflect the T cell immune function of newly treated pulmonary tuberculosis patients,and it has a certain correlation with the clinical efficacy of patients after regular treatment for 6 months.