脊柱结核术后TLR-4、TNF-α、IL-6、IL-17的变化及与预后的相关性研究

Changes of TLR-4,TNF-α,IL-6,and IL-17 after spinal tuberculosis surgery and their correlations with prognosis

目的分析脊柱结核术后Toll样受体(TLR)-4、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、IL-17的变化及与预后的相关性。方法选择2021年1月—2022年12月收治的60例接受手术治疗的脊柱结核患者作为观察组,另选60例非脊柱结核且行脊柱手术的患者作为对照组(部分病例由基金项目中合作医院提供)。检测两组患者血清及病灶组织TLR-4、TNF-α、IL-6、IL-17表达水平。根据观察组患者术后6个月的预后情况,分为预后良好组和预后不良组,比较两组术前及术后6个月的血清TLR-4、TNF-α、IL-6、IL-17表达水平,使用Pearson相关性分析评价脊柱结核患者术前血清TLR-4、TNF-α、IL-6、IL-17表达水平与术后6个月改良巴氏指数(MBI)量表评分的关系,受试者工作特征(ROC)曲线分析术后血清TLR-4、TNF-α、IL-6联合IL-17对脊柱结核术后预后不良的预测效能。结果观察组术前血清及病灶组织的TLR-4、TNF-α、IL-6、IL-17表达水平均高于对照组,差异均有统计学意义(P<0.05);预后不良组术前血清TLR-4、TNF-α、IL-6、IL-17表达水平均高于预后良好组,差异均有统计学意义(P<0.05);术后6个月,预后良好组血清TLR-4、TNF-α、IL-6、IL-17表达水平较术前明显降低,与预后不良组比较,差异均有统计学意义(P<0.05);经Pearson相关性分析,脊柱结核患者术前血清TLR-4、TNF-α、IL-6、IL-17表达水平与术后6个月MBI量表评分呈负相关(P<0.05);经ROC曲线分析,术前血清TLR-4、TNF-α、IL-6联合IL-17预测脊柱结核术后预后不良的ROC曲线下面积为0.921。结论脊柱结核术后血清TLR-4、TNF-α、IL-6、IL-17较术前明显降低,与预后密切相关,术前血清TLR-4、TNF-α、IL-6联合IL-17预测预后不良的效能较好,值得临床予以重视。

Objective To analyze the changes of Toll-like receptor(TLR)-4,tumor necrosis factor(TNF)-α,interleukin(IL)-6,and IL-17 after spinal tuberculosis surgery and their correlations with prognosis.Methods Sixty patients with spinal tuberculosis who received surgical treatment in our hospital from January 2021 to December 2022 were selected as the observation group,and 60 patients without spinal tuberculosis who underwent spinal surgery were selected as the control group(Some cases were from partner hospitals in the Fund).The expression levels of TLR-4,TNF-α,IL-6,and IL-17 in serum and lesion tissues of the two groups were detected.According to the prognosis 6 months after operation,patients in the observation group were divided into a good prognosis group and a poor prognosis group.Serum expression levels of TLR-4,TNF-α,IL-6,and IL-17 were compared between the two groups before and 6 months after operation.Pearson correlation was used to analyze the relationships between the expression levels of serum TLR-4,TNF-α,IL-6,and IL-17 before surgery and the score of modified Babbitt index(MBI)6 months after surgery in patients with spinal tuberculosis.Receiver operating characteristic(ROC)curve was used to analyze the predictive efficacy of serum TLR-4,TNF-α,and IL-6 combined with IL-17 for postoperative poor prognosis of spinal tuberculosis.Results The expression levels of TLR-4,TNF-α,IL-6,and IL-17 in serum and lesion tissues of the observation group were higher than those of the control group before operation,with significant differences(P<0.05).The levels of TLR-4,TNF-α,IL-6,and IL-17 in the poor prognosis group were higher than those in the good prognosis group,with significant differences(P<0.05).Six months after surgery,the expression levels of TLR-4,TNF-α,IL-6,and IL-17 in serum of the good prognosis group were significantly lower than those before surgery,and the differences were statistically significant compared with those of the poor prognosis group(P<0.05).By Pearson correlation analysis,the expression levels of serum TLR-4,TNF-α,IL-6,and IL-17 in patients with spinal tuberculosis before surgery were negatively correlated with MBI scale score 6 months after surgery(P<0.05).According to ROC curve analysis,the area under curve of preoperative serum TLR-4,TNF-α,and IL-6 combined with IL-17 for predicting poor prognosis after spinal tuberculosis surgery was 0.921.Conclusion Serum TLR-4,TNF-α,IL-6,and IL-17 after spinal tuberculosis surgery are significantly lower than those before surgery,which is closely related to prognosis.Preoperative serum TLR-4,TNF-α,and IL-6 combined with IL-17 can predict poor prognosis effectively,which is worthy of clinical attention.