外周血单核细胞及相关细胞因子检测在肺结核中的临床价值

目的回顾性分析初治活动性肺结核(APTB)患者与健康体检者外周血单核细胞及相关细胞因子的动态变化，探讨两者的相关性及临床应用价值。 方法使用迈瑞BC-6900全自动血细胞分析仪检测72例APTB患者(病例组)和79例健康体检者(正常对照组)的外周血血常规，记录单核细胞计数(MO#)和单核细胞百分率(MO%)；测定两组血清白介素-1β(IL-1β)、白介素-6(IL-6)以及肿瘤坏死因子-α (TNF-α)表达水平，然后进行组间指标比较分析，并对单核细胞参数和细胞因子浓度进行相关性分析，同时绘制受试者工作特征(ROC)曲线，评价各指标诊断APTB的敏感度和特异度。 结果病例组外周血MO%、MO#明显高于正常对照组(t值分别为5.135、5.510，P值均<0.05)，APTB患者血清IL-1β、IL-6以及TNF-α浓度与正常对照相比，均发生了明显升高，差异具有统计学意义(U=405.000、P<0.001，U=543.500、P<0.001，U=563.000、P<0.001)。APTB患者外周血MO#与血清IL-6表达水平呈弱负相关(r=-0.247、P<0.05)。项目间诊断性能比较分析显示，指标IL-1β、IL-6以及TNF-α的曲线下面积(AUC)分别为0.891、0.918和0.887均高于MO%和MO#(AUC分别为0.758、0.735)。当IL-1β临界值取9.017 ng/L时，其诊断APTB的敏感度为83.3%，特异度为81.2%；当IL-6临界值取3.835 ng/L时，诊断APTB的敏感度为86.1%，特异度为84.4%；当TNF-α临界值取138.545 ng/L时，其诊断APTB的敏感度为80.6%，特异度为81.2%，均优于MO%(65.3%、62.0%)和MO#(70.8%、64.6%)。此外，同时测量IL-1β，IL-6和TNF-α可获得的曲线下面积高达0.987，其诊断APTB的灵敏度和特异度分别为95.8%和92.8%。 结论结核分枝杆菌感染机体引起APTB，外周血单核细胞迁移至肺泡从而衍变为巨噬细胞(M?)，活化M?产生一系列细胞因子，在机体循环池单核细胞数目变化中可能产生了一定影响，可以作为区分APTB和正常人群的理想标志物。

Clinical value of monocytes and related cytokines in peripheral blood in pulmonary tuberculosis

ObjectiveTo analyze the dynatic changes of monocytes and related cytokines in peripheral blood of patients with active pulmonary tuberculosis (APTB) and in peripheral blood of healthy people retrospectively, so as to explore the correlation between the diseases and the cells, the cytokines, and investigate their clinical application value. MethodsPeripheral blood specimens from 72 patients with APTB and 79 healthy controls were measured by using Myrtle BC-6900 automatic hematology analyzer. Percentage of monocyte (MO%) and monocyte counts (MO#) were recored by the analyzer. Serum levels of Interleukin-1β (IL-1β), Interleukin-6 (IL-6) and Tumor Necrosis Factor-α (TNF-α) were measured in the two groups. Then comparative analysis of the inter-group index was carried out, and the correlation between monocyte parameters and cytokine concentration was analyzed. Operating characteristic (ROC) curve was used to evaluate the sensitivity and specificity of each index in the diagnosis of APTB. ResultsThe peripheral blood Mo% and Mo# in the case group were significantly higher than those in the normal control group (t=5.135, P<0.001 and t=5.510, P<0.001). The serum IL-1β、IL-6 and TNF-α concentrations in the patients with APTB were significantly higher than those in healthy controls and the different was statistically signtficant (U=405.000, P<0.001, U=543.500, P<0.001, and U=563.000, P<0.001). There was a weak negative correlation between Mo# and IL-6 (r=-0.247、P<0.05). A comparative analysis of diagnostic performance between projects showed that AUCs of IL-1β, IL-6 and TNF-α (AUC=0.891, 0.918 and 0.887 respectively) were higher than that of MO% and MO# (AUC=0.758 and 0.735, respectively).When the critical value of IL-1β was 9.0175 ng/l, the sensitivity and specificity of diagnosing APTB were 83.3% and 81.2% respectively; when the critical value of IL-6 was 3.835 ng/l, the sensitivity and specificity of the diagnosing APTB were 86.1% and 84.4% respectively; when the critical value of TNF-α was 138.545 ng/l, the sensitivity and specificity of diagnosing APTB were 80.6% and 81.2%, which were superior to MO% (65.3% vs. 62.0%) and MO# (70.8% vs. 64.6%). In addition, the area under the curve obtained by simultaneous measurement of IL-1β, IL-6 and TNF-α was as high as 0.987, and the sensitivity and specificity of diagnosing APTB were 95.8% and 92.8%, respectively. ConclusionDuring APTB, the peripheral blood mononuclear cells (MO) may migrate to the alveoli and then evolve into macrophages (M?) and the activated M? may produce a series of cytokines, which may have a certain impact on the number of monocytes in the circulating pool and can be used as an ideal marker to distinguish APTB from the normal individuals.