血γ干扰素诱导蛋白10检测对判断肺结核患者治疗效果的价值

目的探讨活动性肺结核患者治疗前后血清γ干扰素诱导蛋白10(IP-10)和全血可溶性γ干扰素释放试验(QFT-GIT)抗原应答的IP-10变化情况。方法搜集2017年1—3月河北省胸科医院收治的经过6~9个月规律抗结核药物治疗后好转的活动性肺结核患者161例。根据治疗前痰涂片抗酸染色结果,分为菌阳肺结核患者(82例)和菌阴肺结核患者(79例)。其中,菌阳肺结核患者根据抗结核药物治疗2个月末痰涂片抗酸染色结果,分为治疗2个月痰菌阴转患者(A组;31例)和治疗2个月痰菌未阴转患者(B组;51例);将菌阴肺结核患者作为C组(79例)。测定三组患者抗结核药物治疗2周内、治疗2个月末、疗程结束后(治疗6~9个月)血清IP-10水平及QFT-GIT抗原应答的IP-10水平,并进行比较。结果A、B、C三组患者治疗2周内、治疗2个月末和疗程结束后的血清IP-10水平分别为(0.16±0.03)μg/L、(0.13±0.03)μg/L、(0.09±0.02)μg/L,(0.16±0.03)μg/L、(0.15±0.03)μg/L、(0.09±0.02)μg/L和(0.16±0.03)μg/L、(0.13±0.03)μg/L、(0.09±0.02)μg/L;QFT-GIT抗原应答的IP-10水平分别为(21.60±3.07)μg/L、(19.94±3.05)μg/L、(11.01±2.16)μg/L,(23.52±3.10)μg/L、(20.50±4.60)μg/L、(12.08±3.57)μg/L和(19.67±3.32)μg/L、(13.43±3.16)μg/L、(8.72±1.08)μg/L。A、B、C组3个治疗时间点血清IP-10和QFT-GIT抗原应答的IP-10水平差异均有统计学意义(F值分别为72.84、111.92、107.52和75.01、118.09、138.98,P值均为0.000)。三组患者疗程结束后血清IP-10、QFT-GIT抗原应答的IP-10水平均低于治疗2周内,差异均有统计学意义(A组q值分别为71.42和138.42;B组q值分别为74.68和150.29;C组q值分别为68.76和129.83,P值均为0.000)。结论血清IP-10及QFT-GIT抗原应答的IP-10水平均可监测治疗效果,可作为监测活动性肺结核治疗效果的潜在生物标志物。

The value of blood interferon-gamma-inducible protein 10 level in assessing the treatment efficacy of pulmonary tuberculosis patients

Objective To investigate the changes of serum interferon-gamma-inducible protein 10 (IP-10) and IP-10 response against tuberculosis specific antigens in QuantiFERON Gold In-Tube (QFT-GIT) assay in patients with active pulmonary tuberculosis before and after treatment. Methods A total of 161 cases of active pulmonary tuberculosis who were improved after 6-9 months of regular antituberculosis treatment in Hebei Provincial Chest Hospital during January 2017 to March 2017 were enrolled in this study. Patients were divided into anti-acid staining (+) group (82 cases) and anti-acid staining (-) group (79 cases) according to the results of sputum smear anti-acid staining before treatment. Anti-acid staining (+) group was further divided into group A (anti-acid staining change (-) after 2 months of treatment, 31 cases) and group B (anti-acid staining still (+) after 2 months of treatment, 51 cases). Anti-acid staining (-) group was defined as the group C (79 cases). The levels of serum IP-10 and IP-10 response to antigen in QFT-GIT assay were measured and compared in all groups within 2 weeks, at the end of 2 months and after 6-9 months of treatment. Results The levels of serum IP-10 within 2 weeks, at the end of 2 months and after 6-9 months of treatment were (0.16±0.03)μg/L, (0.13±0.03)μg/L and (0.09±0.02)μg/L in group A, (0.16±0.03)μg/L, (0.15±0.03)μg/L and (0.09±0.02)μg/L in group B, and (0.16±0.03)μg/L, (0.13±0.03)μg/L and (0.09±0.02)μg/L in group C, respectively. The levels of IP-10 response to antigen in QFT-GIT assay within 2 weeks, at the end of 2 months and after 6-9 months of treatment were (21.60±3.07)μg/L, (19.94±3.05)μg/L and (11.01±2.16)μg/L in group A, (23.52±3.10)μg/L, (20.50±4.60)μg/L and (12.08±3.57)μg/L in group B, and (19.67±3.32)μg/L, (13.43±3.16)μg/L and (8.72±1.08)μg/L in group C, respectively. The differences in the levels of serum IP-10 and IP-10 response to antigen in QFT-GIT assay among the three treatment time points in group A, B and C were all statistically significant (F values were 72.84, 111.92, 107.52 and 75.01, 118.09, 138.98, respectively; Ps=0.000). The levels of serum IP-10 and IP-10 response to antigen in QFT-GIT assay after the course of treatment were lower than those within 2 weeks of treatment, and the differences were statistically significant (group A: q values were 71.42 and 138.42; group B: q values were 74.68 and 150.29; group C: q values were 68.76 and 129.83; Ps=0.000). Conclusion Serum IP-10 and IP-10 response to antigen in QFT-GIT assay can be used as potential biomarkers for monitoring the treatment effect of patients with active pulmonary tuberculosis.