可溶性血管细胞黏附分子1在肺结核发病机制中的作用和临床意义

目的探讨可溶性血管细胞黏附分子1(sVCAM-1)在肺结核发病机制中的作用和临床意义,及其与肿瘤坏死因子α(TNF-α)和γ干扰素(IFN-γ)的关系。方法采用酶联免疫吸附测定(ELISA)法检测未经治疗的35例肺结核患者(肺结核组)、20名健康人(对照组)血清 sVCAM-1、IFN-γ水平,放射免疫分析(RIA)法测定血清 TNF-γ水平。肺结核组中,血型播散性肺结核(Ⅱ型)15例,继发性肺结核(Ⅲ型)20例,后者于治疗2个月后再次采血。结果肺结核组血清 sVCAM-1、TNF-γ和 IFN-γ的水平分别为(822±206)、(1.5±1.1)和(23±13)μg/L,高于对照组(428±73)、(0.2±0.1)和(16±10)μg/L,差异有统计学意义(P 值分别<0.01、<0.01、<0.05);血型播散性肺结核(Ⅱ型)患者的血清 sVCAM-1和 TNF-α的水平分别为(897±144)、(2.0±1.4)μg/L,高于继发性肺结核(Ⅲ型)患者的(765±230)和(1.2±0.6)μg/L,差异有统计学意义(P 值均<0.05);IFN-γ在Ⅱ型与Ⅲ型肺结核患者之间差异无统计学意义(P=0.222)。抗结核治疗后,血清 sVCAM-1和TNF-α水平分别为(532±103)、(0.8±0.8)μg/L,与治疗前相比差异有统计学意义(P 值均<0.01);治疗2个月后 sVCAM-1和 TNF-α水平仍高于对照组(P<0.01);IFN-γ治疗后水平高于治疗前(P<0.05)。肺结核治疗前血清 sVCAM-1与 TNF-α、IFN-γ均呈正相关(r 值分别为0.669、0.560,P 值均<0.01)。对照组和肺结核组治疗后血清 sVCAM-1与 TNF-α、IFN-γ之间均无相关性。结论sVCAM-1可以作为判断病情严重程度和评价疗效的一项临床指标。

The significance of soluble vascular cell adhesion molecule-1 and its relationship with tumor necrosis factor-α and interferon-γ in patients with pulmonary tuberculosis

OBJECTIVE: To explore the clinical significance and the possible role of soluble vascular cell adhesion molecule-1 (sVCAM-1) in the pathogenesis of pulmonary tuberculosis in terms of its relationship with tumor necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma). METHODS: Blood samples were taken from 35 patients with pulmonary tuberculosis before therapy, including military pulmonary tuberculosis (type II) in 15 cases and secondary pulmonary tuberculosis (type III) in 20 cases. After 2 month therapy, samples were taken from 20 cases with type III tuberculosis again. Twenty healthy volunteers served as controls. Serum concentrations of sVCAM-1 and IFN-gamma were detected by ELISA method and TNF-alpha by radioimmunoassay. RESULTS: The serum concentrations of sVCAM-1, TNF-alpha and IFN-gamma in patients with pulmonary tuberculosis were (822 +/- 206) microg/L, (1.5 +/- 1.1) microg/L, and (23 +/- 13) microg/L, respectively; all were significantly higher than those in healthy controls (428 +/- 73), (0.2 +/- 0.1), and (16 +/- 10) microg/L; P < 0. 01, P < 0.01, and P < 0.05, respectively]. In the subgroup of patients with military pulmonary tuberculosis, the concentrations of sVCAM-1 and TNF-alpha were (897 +/- 144) microg/L and (2.0 +/- 1.4) microg/L, respectively, which were higher than those in patients with secondary pulmonary tuberculosis (765 +/- 230) microg/L and (1.2 +/- 0.6) microg/L, respectively, both P < 0.05]. The difference in the concentrations of IFN-gamma between type II and type III was not significant (P = 0.222). The levels of sVCAM-1 and TNF-alpha were lower after therapy (532 +/- 103) and (0.8 +/- 0.8) microg/L, respectively] than those before therapy (both P < 0.01), but the levels of sVCAM-1 and TNF-alpha after therapy were still higher than those in healthy controls (both P < 0.01). The level of IFN-gamma was higher after therapy than that before therapy (P < 0.05), and the difference between the level after therapy and that of the controls was significant. There were significant correlations between VCAM-1 and TNF-alpha and IFN-gamma respectively in untreated pulmonary tuberculosis (r = 0.669 and 0.560, respectively both P < 0.01). CONCLUSION: The measurement of serum sVCAM-1 is useful to evaluate the severity of disease and to monitor activity of the disease during chemotherapy.