Th1/Th2细胞因子及nCD64指数在肺癌早期感染监测与治疗中的应用价值

Value of Th1/Th2 cytokines and nCD64 index in early infection monitoring and treatment of lung cancer

目的评估Th1/Th2细胞因子及中性粒细胞CD64(neutrophil CD64,nCD64)指数在肺癌早期感染监测与治疗中的应用价值。方法选取2020年5月至2022年4月福建医科大学附属南平第一医院收治的160例肺癌患者作为肺癌组,同时选取健康体检人员80人作为正常对照组。肺癌组又分为肺癌感染组(n=80)和肺癌非感染组(n=80)。肺癌感染组采用经验性抗感染药物及化学药物治疗,肺癌非感染组只采用化学药物治疗。在治疗第0、7、14、21天后检测各组患者白细胞介素(interleukin,IL)-2、IL-4、IL-6、IL-10、γ干扰素(interferon-gamma,IFN-γ)、肿瘤坏死因子(tumor necrosis factor,TNF-α)、CD64水平,并计算nCD64指数值。结果肺癌感染组中,白色念珠菌的感染率最高,占总数的67.5%。与正常对照组相比,在治疗后第0、7天时,肺癌非感染组的IL-2、TNF-α、IFN-γ均显著降低(P<0.05),IL-4、IL-6、IL-10、n CD64指数均显著升高(P<0.05);治疗第14天时,肺癌非感染组的IL-2、TNF-α、IFN-γ均显著降低,IL-6、IL-10、n CD64指数均显著升高(P<0.05);治疗第21天时,肺癌非感染组与正常对照组各项指标比较,差异均无统计学意义(P>0.05)。与肺癌非感染组比较,在治疗后第0、7、14天时,肺癌感染组IL-2和IFN-γ均显著降低(P<0.05),IL-4、IL-6、IL-10、n CD64指数均显著升高(P<0.05);治疗第21天时,肺癌非感染组与肺癌感染组组各项指标比较,差异均无统计学意义(P>0.05)。nCD64指数的曲线下面积(area under the curve,AUC)为0.925,95%置信区间(confidence interval,CI):0.875~0.975;IL-6的AUC为0.889,95%CI:0.835~0.943。nCD64指数和IL-6的截断值分别为5.25pg/ml、11.45pg/ml,敏感度分别为95.6%、92.3%,特异性分别为83.7%、78.9%,诊断效能较好。结论n CD64、IL-6可作为肺癌患者早期感染指标,且nCD64指数的预测效能优于IL-6。

Objective To evaluate the value of Th1/Th2 cytokines and neutrophil CD64(nCD64)index in the monitoring and treatment of early infection in lung cancer.Methods A total of 160 lung cancer patients admitted to the First Affiliated Hospital of Fujian Medical University from May 2020 to April 2022 were selected as the lung cancer group,while 80 healthy medical examiners were selected as the normal control group.The lung cancer group was subdivided into lung cancer infection group(n=80)and lung cancer non-infection group(n=80).The lung cancer infected group was treated with empirical anti-infective drugs and chemotherapy,while the lung cancer non-infected group was treated with chemotherapy only.The levels of interleukin(IL)-2,IL-4,IL-6,IL-10,interferon-gamma(IFN-γ),tumor necrosis factor(TNF-α),and CD64 were measured in each group after the 0 day,7 days,14 days,and 21 days after treatment,and the nCD64 index value was calculated.Results Candida albicans had the highest infection rate in the lung cancer infection group,accounting for 67.5%of the total.Compared with the normal control group,at 0 and 7 days after treatment,IL-2,TNF-α,and IFN-γin the lung cancer non-infection group were significantly lower(P<0.05),and IL-4,IL-6,IL-10,and nCD64 index were significantly higher(P<0.05).At the 14 days after treatment,IL-2,TNF-α,and IFN-γin the lung cancer non-infection group were significantly lower,and IL-6,IL-10,and nCD64 index were significantly higher(P<0.05).At the 21 days after treatment,the differences between the lung cancer non-infected group and the normal control group in each index were not statistically significant(P>0.05).Compared with the lung cancer non-infected group,at the 0 day,7 days and 14 days after treatment,IL-2 and IFN-γin the lung cancer infected group were significantly decreased(P<0.05),and IL-4,IL-6,IL-10 and nCD64 index were significantly increased(P<0.05).At the 21 days after treatment,the differences in the indexes between the lung cancer non-infected and lung cancer infected groups were statistically not significant(P>0.05).The area under the curve(AUC)of nCD64 index was 0.925,95%confidence interval(CI):0.875-0.975;the AUC of IL-6 was 0.889,95%CI:0.835-0.943.The cut-off values of nCD64 index and IL-6 were 5.25pg/ml and 11.45pg/ml,with sensitivities of 95.6%and 92.3%,and specificities of 83.7%and 78.9%,respectively,for good diagnostic efficacy.Conclusions The nCD64 index and IL-6 can be used as predictors of early infection risk in lung cancer patients,and the predictive efficacy of the nCD64 index is better than that of IL-6.