细胞因子联合检测对活动性结核与潜伏性结核鉴别诊断的预测价值分析

Application of combined CKs to differentiate active and latent tuberculosis infection

摘要:

目的  探索细胞因子联合检测在结核患者潜伏性感染及活动性感染鉴别诊断中的预测价值。以期在细胞因子水平找到能够区分结核活动性感染和潜伏性感染的指标，为临床诊断结核提供新的依据。方法  采用流式微球阵列法检测72例确诊为活动性肺结核患者，57例确诊为潜伏性感染者的23种血清细胞因子的水平，分析单个细胞因子在潜伏性感染及活动性感染鉴别诊断中的价值，最后进一步用统计学方法分析多个细胞因子联合检测的诊断价值。结果  相比于潜伏性感染组，活动性结核组白细胞介素15（IL-15）、干扰素诱导蛋白10（IP-10）、白细胞介素8（IL-8）、白细胞介素2（IL-2）、血清白细胞介素2受体a（IL-2Ra）、巨噬细胞炎症蛋白a（MIP-1a）这6种细胞因子水平均升高（P <0.05）；其余白细胞介素4（IL-4）、白细胞介素6（IL-6）等17种细胞因子在血清中的含量两组之间差异无统计学意义（P >0.05）；在结核活动性的鉴别诊断中，3个细胞因子的AUC值大于0.8，分别为IL-8（0.83）、IL-15（0.89）、IP-10（0.93）；（IL-8  & IL-15）、（IL-8 & IP-10）和（IL-15 & IP-10）两个细胞因子联合检测优于任一单细胞因子的诊断价值（P <0.05）；（IL-8  & IL-15 & IP-10）3个细胞因子联合检测时，曲线下面积值为0.97，可显著提升活动性结核诊断的敏感性和特异性。结论  在IFN-γ释放实验的基础上，IL-8 、IL-15 、IP-10联合检测可以作为区分活动性和潜伏性结核的理想标志物。

Abstract:

Objective To find a new marker which can differentiate active tuberculosis infection and latent tuberculosis infection at the level of cytokine, and to provide new evidence for clinical diagnosis of tuberculosis. Methods Levels of 23 CKs of TB specific antigen from active or latent tuberculosis were evaluated by cytometric bead array. ROC analysis was used to test each CK and the combination of the CKs on the diagnosis of active tuberculosis. Results Compared with latent tuberculosis infection group, the levels of IL-15, IP-10, IL-8, IL-2R, sIL-2Ra, MIP-1ain the active tuberculosis infection group were significantly increased (P < 0.05); Another 17 CKs like IL-4 and IL-6 had no significant difference between the two groups. The AUC value of IL-8 (0.83), IL-15 (0.89), IP-10 (0.93) was beyond 0.8. Combination of (IL-8 & IL-15), (IL-8 & IP-10) or (IL-15 & IP-10) had a greater value than one CK, P < 0.05. The AUC value of (IL-8 & IL-15& IP-10) was significantly increased compared with the combination of two CKs. Conclusions Combination detection of IL-8, IL-15, IP-10 is the ideal marker for differentiation active tuberculosis infection from latent tuberculosis infection.