布鲁氏菌病患者菌型鉴定及T淋巴细胞亚群和IL-6与IFN-γ的诊断价值

Pathogens identification and diagnostic value of T lymphocyte subsets,IL-6 and IFN-in patients with brucellosis infection

目的探究布鲁氏菌病患者菌型鉴定及T淋巴细胞亚群和白细胞介素-6(IL-6)与干扰素-γ(IFN-γ)及其诊断价值.方法选择2018年3月-2021年6月中国医科大学附属第一医院收治的106例布鲁氏菌病患者为研究对象,对布鲁氏菌给予生物学及菌种鉴定.根据病程将其分为急性组与慢性组,比较两组T淋巴细胞亚群及IL-6、IFN-γ水平,分析其与布鲁氏菌病慢性化的关系及其诊断价值;对急性组患者均给予针对性治疗,根据治疗后临床疗效将其分为有效组及无效组,分析外周血T淋巴细胞亚群及IL-6、IFN-γ及对临床疗效的诊断价值.结果经多重聚合酶链式反应(PCR)检验分析得,106株临床分离的布鲁氏菌株中检出布鲁氏菌羊种生物3型菌株86株、羊种生物2型菌株17株、猪种生物1型菌株3株;急性组CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)比例高于慢性组,CD_(8)^(+)比例及IL-6、IFN-γ低于慢性组(P<0.05);T淋巴细胞亚群及IL-6、IFN-γ联合检测诊断布鲁氏菌病慢性化的曲线下面积(AUC)大于各指标单独检测(P<0.05);有效组治疗后CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)高于无效组,CD_(8)^(+)比例及IL-6、IFN-γ低于无效组(P<0.05);急性期患者治疗后T淋巴细胞亚群及IL-6、IFN-γ水平联合检测评估临床疗效的AUC大于各指标单独检测(P<0.05).结论布鲁氏菌羊种生物3型为布鲁氏菌病感染的主要菌型,患者外周血指标联合检测对疾病慢性化及急性期患者治疗疗效具有评估价值,且其T淋巴细胞亚群比例及IL-6水平异常或与疾病进展和疗效相关.

OBJECTIVE To investigate the identification of pathogens and diagnostic value of T lymphocyte subsets.interleukin-6(IL-6)and interferon-γ(IFN-γ)in patients with brucellosis infection.METHODS A total of 106 pa­tients with brucellosis infection admitted to the First Affiliated Hospital of China Medical University between Mar.2018 and Jun.2021 were selected as the study subjects.Biology and strain identification of brucellosis were conducted.According to disease course,the patients were divided into acute group and chronic group.The levels of lymphocyte subgroups,II,6 and IFN-y between the two groups were compared,and their relationship with the chronicity of brucellosis and their diagnostic value were analyzed.The patients in acute group were given targeted treatment and were divided into effective group and ineffective group according to the clinical efficacy after treat ment.The correlation beween T lymphocyte subsetsIL-6,IFN-y and curative effect,and their diagnostic value were analyzed.RESULTS Multiple polymerase chain reaction(PCR)analysis showed that in the 106 clinically isolated brucellosis strains,there were 86 strains of type 3 Brucella melitensis,17 strains of type 2 Brucella melitensis and 3 strains of type1Brucella suis.The CD_(4)^(+)and CD_(4)^(+)/CD_(8)^(+)ratio in theacutegroupwerehigher than those in the chronic group,while CD_(4)^(+)ratio,IL-6 and IFN-were lower than those in the chronic group(P<0.05).The area under the curve(AUC)of T lymphocyte subsets combined with IL-6 and IFN-in the diagnosis of brucellosis chronicity was greater than that of each indicator alone(P<0.05).After treatment,CD_(4)^(+)and CD_(4)^(+)/CD_(8)^(+)in the effective group were higher than those in the ineffective group,while CD_(8)^(+)ratio,IL-6 and IFN-were lower than those in the ineffective group(P<0.05).AUC of T lymphocyte subsets combined with IL-6 and IFN-for evaluating clinical curative effect was greater than that of that of each indicator alone(P<0.05).CONCLUSION The main type of Brucellosis infection was type 3 Brucella melitensis.The combined detection of peripheral blood indicators were evaluable in assessing the efficacy of treatment in patients with chronic and acute disease,and their abnormal T lymphocyte subpopulation ratios and IL-6 levels might be associated with disease progression and curative effect.