变应性鼻炎患者外周血Th1/Th2型细胞因子表达意义及其对气道高反应性的预测价值研究

Significance of Th1/Th2 cytokines expression in peripheral blood of patients with allergic rhinitis and its predictive value for airway hyperreactivity

目的分析变应性鼻炎(AR)患者外周血Th1/Th2型细胞因子表达意义及其对气道高反应性的预测价值。方法选定海安市人民医院2020年1月—2022年1月接诊的50例AR患者,同期选取海安市人民医院门诊体检的50例健康体检者作为对照组,检测、比较两组血清Th1细胞因子[干扰素-γ(IFN-γ)、肿瘤坏死因子-α(TNF-α)]、Th2细胞因子[白细胞介素-5(IL-5)、白细胞介素-4(IL-4)],对比AR患者中轻度、中重度组血清Th1、Th2细胞因子;根据气道反应是否正常将AR患者分为两组,27例气道反应正常的患者设为气道反应正常组,23例气道高反应的患者设为气道反应异常组,比较两组血清Th1、Th2细胞因子,绘制受试者工作曲线(ROC),计算曲线下面积(AUC),分析血清Th1、Th2细胞因子对气道高反应的预测价值。结果AR患者血清IFN-γ均低于对照组(P<0.05),AR患者血清TNF-α、IL-4、IL-5均高于对照组(P<0.05)。中重度AR患者血清IFN-γ均低于轻度组、对照组(P<0.05),中重度AR患者血清TNF-α、IL-4、IL-5均高于轻度组、对照组(P<0.05)。气道反应异常组血清IFN-γ低于气道反应正常组(P<0.05),气道反应异常组血清TNF-α、IL-4、IL-5均高于气道反应正常组(P<0.05)。血清IFN-γ、TNF-α、IL-4、IL-5联合检测预测气道高反应的AUC是0.792,(95%CI:0.713-0.943),灵敏度、特异度分别是93.58%、91.02%,均高于单独检测(P<0.05)。结论AR患者血清Th1、Th2细胞因子呈异常表达,且血清Th1、Th2细胞因子与气道高反应存在一定相关性,临床可通过联合检测血清Th1、Th2细胞因子,提高对气道高反应的预测价值。

Objective To explore the significance of Th1/Th2 cytokines expression in peripheral blood of patients with allergic rhinitis(AR)and its predictive value for airway hyperreactivity.Methods Fifty AR patients visited our department from January 2020 to January 2022 were selected as the observation group,and 50 healthy volunteers undergoing physical examination in the outpatient department of our hospital during the same period were selected as the control group.Serum levels of Th1 cytokines[interferon-γ(IFN-γ),tumor necrosis factor-α(TNF-α)]and Th2 cytokines[interleukin-5(IL-5),interleukin-4(IL-4)]were detected and compared between the two groups,and between the mild and moderate to severe AR patients.The 50 AR patients were subdivided into normal group(n=27)and abnormal group(n=23)according to whether the airway response was normal or not.Serum levels of Th1 and Th2 cytokines were compared between the two subgroups,receiver operating curve(ROC)was drawn,and area under curve(AUC)was calculated to analyze the predictive value of serum Th1 and Th2 cytokines on airway hyperresponsiveness.Results The serum level of IFN-γof the observation group was lower than that of the control group(P<0.05),and the serum levels of TNF-α,IL-4 and IL-5 of the observation group were higher than those of the control group(P<0.05).The serum level of IFN-γof the moderate to severe AR group was lower than those of the mild AR group and the control group(P<0.05),and the serum levels of TNF-α,IL-4 and IL-5 of the moderate to severe AR group were higher than those of the mild AR group and the control group(P<0.05).The serum level of IFN-γin the abnormal airway response group was lower than that in the normal airway response group(P<0.05),and the serum levels of TNF-α,IL-4 and IL-5 in the abnormal airway response group were higher than those in the normal airway response group(P<0.05).The AUC of serum IFN-γ,TNF-α,IL-4 and IL-5 combined detection was 0.792(95%CI:0.713-0.943),and the sensitivity and specificity were 93.58%and 91.02%,respectively,which were higher than those of single detection(P<0.05).Conclusion Th1 and Th2 cytokines are abnormally expressed in serum of AR patients,and there are certain correlations between serum Th1 and Th2 cytokines and airway hyperresponse.In clinical practice,combined detection of serum Th1 and Th2 cytokines can improve the predictive value for airway hyperresponsiveness.