不同临床类型结核病患者血清白细胞介素-21水平及其临床意义

目的探讨不同临床类型结核病患者白细胞介素-21(IL-21)表达水平及其与结核抗体间的相关性。方法选取2014年10月至2018年6月昆明医学院第六附属医院感染科初治结核病患者共180例,根据患者结核发病部位分为肺结核组(99例,其中包括结核性胸膜炎患者37例)和肺外结核组(81例),选取同期体检的健康志愿者作为对照组(140例),运用酶联免疫吸附试验(ELISA)检测结核病患者抗结核分枝杆菌治疗前后血清IL-21水平和抗结核分枝杆菌抗体,以及结核性胸膜炎患者抗结核分枝杆菌治疗前胸水IL-21水平,分析血清IL-21水平与结核分枝杆菌抗体的相关性。结果在抗结核分枝杆菌治疗前,肺结核组[43.16(72.98)pg/ml]和肺外结核组[38.68(58.17)pg/ml]患者血清IL-21水平均低于健康对照组[59.49(42.41)pg/ml],差异均有统计学意义(Z=-2.788、P=0.005,Z=-2.788、P=0.005);但肺结核组和肺外结核组差异无统计学意义(Z=-0.052、P=0.961)。经过强化期抗结核分枝杆菌治疗,肺结核组和肺外结核组患者血清IL-21水平均显著回升[60.21(57.58)pg/ml vs. 43.16(72.98)pg/ml,Z=-2.681、P=0.007;66.16(42.21)pg/ml vs. 38.68(58.17)pg/ml,Z=-2.422、P=0.015]。肺结核组中结核性胸膜炎患者胸水IL-21水平显著高于其抗结核分枝杆菌治疗前血清IL-21水平[121.36(133.67)pg/ml vs. 49.09(80.67)pg/ml,Z=-3.477、P=0.001]。结论结核病患者血清IL-21水平降低,并于抗结核分枝杆菌治疗后回升,提示IL-21水平可作为观察结核病患者疗效及临床转归的指标。

Expression and clinical significance of serum interleukin-21 in patients with different types of tuberculosis

ObjectiveTo investigate the expression level of interleukin 21 (IL-21) and its correlation with tuberculosis antibody in patients with different clinical types of tuberculosis. MethodsFrom October 2014 to June 2018, a total of 180 patients with primary tuberculosis in The Sixth Affiliated Hospital of Kunming Medical University were divided into two groups according to the lesion locations: pulmonary tuberculosis group (n = 99, including 37 cases with tuberculous pleurisy) and extrapulmonary tuberculosis group (n = 81); while 140 healthy volunteers were selected as control group. The levels of serum IL-21 and anti-Mycobacterium tuberculosis antibody in the patients with tuberculosis before and after anti-Mycobacterium tuberculosis treatment were detected by Enzyme linked immunosorbent assay (ELISA). IL-21 levels in pleural effusions were detected in patients with tuberculosis pleurisy before treatment. The correlation between serum IL-21 level and anti-Mycobacterium tuberculosis expression was analyzed. ResultsBefore anti-Mycobacterium tuberculosis treatment, the serum IL-21 levels in both pulmonary tuberculosis patients [43.16 (72.98) pg/ml] and extrapulmonary tuberculosis patients [38.68 (58.17) pg/ml] were lower than those of healthy controls [59.49 (42.41) pg/ml], with significant differences (Z =-2.788, P = 0.005; Z =-2.788, P = 0.005); but there was no significant difference between pulmonary tuberculosis group and extrapulmonary tuberculosis group (Z = -0.052, P = 0.961). After intensive anti-Mycobacterium tuberculosis treatment, the serum IL-21 levels of both pulmonary tuberculosis and extrapulmonary tuberculosis patients were significantly increased [60.21 (57.58) pg/ml vs. 43.16 (72.98) pg/ml; Z =-2.681, P = 0.007; 66.16 (42.21) pg/ml vs. 38.68 (58.17) pg/ml; Z =-2.422, P = 0.015]. The average level of IL-21 in pleural effusion of patients with tuberculous pleurisy in pulmonary tuberculosis group was significantly higher than their serum IL-21 level before anti-Mycobacterium tuberculosis [121.36 (133.67) pg/ml vs. 49.09 (80.67) pg/ml; Z =-3.477, P = 0.001]. ConclusionsThe level of serum IL-21 in patients with active tuberculosis decreased and increased after anti-Mycobacterium tuberculosis, suggesting that the level of IL-21 may be used as an index for observing the effect or clinical outcome of patients with tuberculosis.