血清MIF、TNF-α、IFN-γ水平动态监测在活动性肺结核患者疾病转归评估中的应用价值

Application value of dynamic monitoring of serum MIF,TNF-αand IFN-γlevels in the evaluation of disease outcome in patients with active pulmonary tuberculosis

目的动态监测活动性肺结核(APTB)患者血清相关细胞因子——肿瘤坏死因子-α(TNF-α)、γ干扰素(IFN-γ)、移动抑制因子(MIF)水平,分析其在APTB患者疾病转归评估中的应用价值。方法选择2019年1月至2021年10月该院收治的APTB患者136例,给予APTB常规治疗,根据治疗后病情转归情况分为转归组(结核得到控制,93例)和未转归组(结核未控制,43例)。检测两组患者治疗前,治疗1、2、3个疗程后血清MIF、TNF-α、IFN-γ水平及肺部感染评分(CPIS),分析血清相关细胞因子水平与CPIS评分的关系及对疾病转归的预测价值。结果两组患者治疗1、2、3个疗程后血清MIF、TNF-α、IFN-γ水平及CPIS评分均较治疗前下降,且转归组均低于未转归组,差异均有统计学意义(P<0.05);治疗1、2、3个疗程后CPIS评分与血清MIF(r=0.581、0.782、0.663,P<0.05)、TNF-α(r=0.604、0.749、0.712,P<0.05)、IFN-γ(r=0.585、0.767、0.658,P<0.05)均呈相关;MIF、TNF-α、IFN-γ联合预测APTB患者疾病转归的曲线下面积明显高于各指标单独检测及两两联合检测,差异均有统计学意义(P<0.05)。结论血清MIF、TNF-α、IFN-γ水平与APTB患者肺部感染情况、疾病转归密切相关,动态监测血清相关细胞因子水平可有效评估APTB患者预后,对临床治疗、预后改善均具有指导意义。

Objective To dynamically monitor serum related cytokines-tumor necrosis factor-α(TNF-α),interferon-γ(IFN-γ)and migration inhibitory factor(MIF)levels in patients with active pulmonary tuberculosis(APTB),and to analyze their application value in the evaluation of disease outcome in APTB patients.Methods A total of 136 APTB patients admitted to this hospital from January 2019 to October 2021 were selected and given routine treatment of APTB.According to the outcome of the disease after treatment,they were divided into the outcome group(tuberculosis was controlled,93 cases)and the non-outcome group(tuberculosis was uncontrolled,43 cases).The serum MIF,TNF-α,IFN-γlevels and clinical pulmonary infection score(CPIS)were detected before treatment and after 1,2 and 3 courses of treatment in the two groups.The relationship between serum levels of related cytokines and CPIS score and the predictive value of serum levels of related cytokines to disease outcome were analyzed.Results After 1,2 and 3 courses of treatment,the serum MIF,TNF-α,IFN-γlevels and CPIS score in the two groups were lower than those before treatment,and which in the outcome group were lower than those in the non-outcome group,and the differences were statistically significant(P<0.05).After 1,2 and 3 courses of treatment,CPIS score was correlated with serum MIF(r=0.581,0.782,0.663,P<0.05),TNF-α(r=0.604,0.749,0.712,P<0.05),IFN-γ(r=0.585,0.767,0.658,P<0.05).The area under the curve of MIF,TNF-αand IFN-γcombined prediction for the disease outcome of APTB was higher than that of single detection and pairwise detection of the above three indicators,and the difference was statistically significant(P<0.05).Conclusion Serum MIF,TNF-αand IFN-γlevels are closely related to pulmonary infection and disease outcome in APTB patients.Dynamic monitoring of serum levels of related cytokines can effectively evaluate the prognosis of APTB patients,which has guiding significance for clinical treatment and prognosis improvement.