肺结核患者治疗过程中血清IFN-γ表达水平变化分析

Change in serum expression level of IFN-γduring pulmonary tuberculosis treatment

目的分析血清中干扰素-γ(IFN-γ)水平在肺结核治疗过程中的变化趋势,探讨其可能的影响因素,为明确肺结核治疗过程中血清IFN-γ水平监测的意义提供依据。方法收集2020年9月至2022年12月就诊于广州市胸科医院的56例肺结核患者的血清,利用流式细胞术检测患者治疗前、治疗2个月和治疗6个月血清中IFN-γ的浓度。不符合正态分布的计量资料组间比较采用Kruskal-Wallis和Mann-Whitney检验,配对样本使用Friedman检验。结果肺结核患者血清中的IFN-γ浓度在治疗过程中呈下降趋势,差异有统计学意义(P=0.004)。具有肺部空洞的肺结核患者治疗前血清中IFN-γ浓度高于无肺部空洞的患者,差异有统计学意义。受试者工作特征曲线(ROC)分析显示,血清中IFN-γ的浓度在区分肺结核治疗前与治疗2个月、治疗前与治疗6个月时曲线下面积分别为0.582和0.646,界值分别为1.520和2.345 ng/L,灵敏度分别为91.10%和44.60%,特异度分别为32.10%和69.60%。二元logistic回归分析表明,治疗2个月后血清中IFN-γ浓度是否降到1.520 ng/L以下与是否患有糖尿病有关。当将入组病例限制到治疗前病原学阳性时,ROC分析显示血清中IFN-γ浓度区分治疗前与治疗2个月、治疗前与治疗6个月的曲线下面积分别为0.762和0.770,界值分别为1.725和1.705 ng/L,灵敏度均为93.75%,特异度均为50.00%。结论治疗前肺结核患者血清IFN-γ的浓度与肺部有无空洞有关,治疗过程中总体呈下降趋势,其变化与患者是否合并糖尿病、治疗前患者病原学结果有关。

Objective To evaluate the change trend of serum interferon-γ(IFN-γ)level during pulmonary tuberculosis treatment,to explore the possible influencing factors,and to provide evidences for the significance of serum IFN-γlevel monitoring in the course of pulmonary tuberculosis treatment.Methods The serum of 56 patients with pulmonary tuberculosis treated at Guangzhou Chest Hospital from September 2020 to December 2022 was collected and measured by flow cytometry before the treatment and after 2 and 6 months'treatment.The measurement data not of normal distribution were compared by Kruskal-Wallis and Mann-Whitney tests.Friedman test was used for the paired samples.Results The serum concentration of IFN-γin the patients with pulmonary tuberculosis decreased during the treatment,with a statistical difference(P=0.004).Before the treatment,the serum concentration of IFN-γin the patients with pulmonary cavity was higher than that in the patients without pulmonary cavity,with a statistical difference.When the serum concentration of IFN-γwas used to distinguish between before and 2 months after the treatment and between before and 6 months after the treatment,the areas under receiver operating characteristic curves(ROC)were 0.582 and 0.646;the cut-off values were 1.520 and 2.345 ng/L;the sensitivities were 91.10%and 44.60%;the specificities were 32.10%and 69.60%.Binary logistic regression analysis showed that whether serum IFN-γconcentration fell below 1.520 ng/L after 2 months'treatment was related to whether the patients had diabetes.When the enrolled cases were limited to the positive etiopathogenesis before the treatment and when the serum concentration of IFN-γwas used to distinguish between before and 2 months after the treatment and between before and 6 months after the treatment,the areas under ROC were 0.762 and 0.770;the cut-off values were 1.725 and 1.705 ng/L;the sensitivities both were 93.75%;the specificities both were 50.00%.Conclusion The concentration of serum IFN-γbefore pulmonary tuberculosis treatment is related to whether or not there is a cavity in the lungs,and the overall trend of decrease during the treatment is related to whether the patients are complicated with diabetes and the patients'etiological results before treatment.