2023年甘肃省某医院结核病患者尿液和肺泡灌洗液细胞因子临床价值分析

Study of value of cytokine detection in urine and lavage fluid of tuberculosis patients in clinical application in a hospital in Gansu,2023

目的 研究结核病患者尿液、肺泡灌洗液中细胞因子的水平,探讨细胞因子在结核病诊断中的作用。方法 采用病例–对照的研究方法,选择2023年1月至2023年7月在甘肃省兰州市肺科医院就诊及体检筛查结核感染的人群,按照纳入和排除标准,共纳入153例患者做为研究对象,其中结核病病原学阳性确诊患者74例,纳入活动性结核组;体检筛查人群中γ-干扰素释放试验(IGRA)结果为阳性27例患者,纳入结核潜伏感染组;肺炎、支气管扩张及肿瘤等非结核病患者52例,经IGRA实验阴性后纳入阴性对照组。对三组患者尿液和肺泡灌洗液样本,采用双抗体夹心酶联免疫吸附实验检测γ-干扰素(IFN-γ)、肿瘤坏死因子-α(TNF-α)、白细胞介素2(IL-2)、白细胞介素4(IL-4)、白细胞介素6(IL-6)、白细胞介素10(IL-10)、白细胞介素17(IL-17)和白细胞介素22(IL-22)等8种细胞因子的表达水平。结果 尿液样本中,活动性结核组IFN-γ、IL-2和IL-10均低于另两组水平,差异有统计学意义(P<0.05),TNF-α,IL-4,IL-6,IL-17和IL-22在三组中差异无统计学意义(P>0.05);肺泡灌洗液样本中,活动性结核组IFN-γ、IL-2和IL-10均低于另两组水平,活动性结核组IL-6均高于另两组水平,差异有统计学意义(P<0.05),TNF-α,IL-4,IL-17和IL-22在三组中差异均无统计学意义(P>0.05)。结论 活动性结核病患者尿液和肺泡灌洗液中IFN-γ、IL-2和IL-10表达水平降低以及肺泡灌洗液中IL-6表达水平升高,可为活动性结核病的诊断提供一定的参考价值。

Objective To investigate the levels of cytokines in urine and lavage fluid of the patients with tuberculosis(TB)and explore the role of cytokines in the diagnosis of TB.Methods A case-control study was conducted in 153 suspected patients who were treated and screened for TB in Lanzhou Pulmonary Hospital,Gansu from January 2023 to July 2023.According to the inclusion and exclusion criteria,a total of 74 patients with etiologically confirmed TB were classified as the active TB group,27 cases with positive interferon(IFN-γ)test results were classified as latent infection group.52 pneumonia,bronchiectasis and tumor patients with negative IFN-γtest results were classified as negative control group.The epidemiological and clinical data,urine and lavage fluid samples of the cases were collected.The expression levels of 8 cytokines,including interferon(IFN-γ),tumor necrosis factor(TNF-α),interleukin 2(IL-2),interleukin 4(IL-4),interleukin 6(IL-6),interleukin 10(IL-10),interleukin 17(IL-17)and interleukin 22(IL-22),were detected by double antibody sandwich enzyme-linked immunosorbent assay.The data were statistically analyzed and P<0.05 was considered statistically significant.Results Eight cytokines were detected in urine and lavage fluid of 153 subjects included in the study.In urine samples,the expression levels of IFN-γ,IL-2 and IL-10 in the active TB group were lower than those in the other two groups,the differences were significant(P<0.05).There were no significant differences in TNF-α,IL-4,IL-6,IL-17 and IL-22 expression levels among the three groups(P>0.05).In the lavage fluid samples,the expression levels of IFN-γ,IL-2 and IL-10 in the active TB group were lower than those in the other two groups,and the expression level of IL-6 in the active TB group was higher than those in the other two groups,the differences were significant(P<0.05),while the differences in expression levels of TNF-α,IL-4,IL-17 and IL-22 were not significant among the three groups(P>0.05).Conclusion Decreased expression of IFN-γ,IL-2 and IL-10 in urine and lavage fluid and increased expression of IL-6 in lavage fluid might be used as reference in the diagnosis of active TB.