摘要目的 研究肺结核患者体内结核病相关细胞因子的动态变化.方法 从广州市黄埔区、深圳市宝安区、佛山市及东莞市结核病防治机构选取活动性结核病患者68例,男36例,女32例,年龄19～ 50岁,平均(30 ±9)岁.肺结核患者按门诊顺序纳入,采用我国抗结核标准化疗方案治疗,并根据疗程结束后病情转归情况分为完成治疗组(治愈或者临床治愈)38例,男17例,女21例,平均29岁和未完成治疗组(治疗失败或需延长治疗)30例,男19例,女11例,平均32岁.采集入院时、治疗后2个月末及6个月末的外周血清,采用ELISA方法检测血清中γ-干扰素(IFN-γ)、IL-4、IL-17、肿瘤坏死因子-α(TNF-α)、转化生长因子-β(TGF-β)及IL-10等细胞因子的含量,采用SPSS20.0统计软件,多组间均数比较采用配对t检验分析.结果 所有纳入病例的IFN-γ在入院时、2个月末及6个月末的平均含量分别为23.2、22.2和22.3 ng/L;TGF-β的含量分别为169.1、142.3和123.2 ng/L;IL-4的含量分别为65.0、28.7和31.9 ng/L,3种细胞因子水平随疗程的延长而显著降低(t=2.67,2.35及3.41,均P＜0.05);6个月末时,完成治疗组IL-10显著升高,达12.9 ng/L,未完成治疗组显著降低(P＜0.05);完成治疗组的IL-4水平降低(5.4 ng/L,P＜0.05),而未完成治疗组无变化;完成治疗组Th1/Th2(IFN--γ/IL-4)入院时为0.70,2个月末为1.21,6个月末为1.34(t=6.32,6.03和5.85,均P＜0.05),而未完成治疗组分别为0.64和0.75(t =3.7,P＜0.05),完成治疗组2个月末和6个月末的Th1/Th2比值显著高于未完成治疗组(t=7.11,P＜0.05).结论 IFN-γ及TGF-β等Th1型细胞因子或Th1/Th2降低可能是影响患者预后的因素之一,可能对患者的预后产生不良影响.

abstractsObjective To study the dynamic changes of tuberculosis related cytokines among patients during the different courses of treatment,and to analyze their influences on the development and prognoses of tuberculosis.Methods All patients with active tuberculosis were enrolled from Guangzhou,Shenzhen and Foshan TB control institutes.There were a total of 68 cases,36 males and 32 females,aged 19 to 50 years[average (30 ± 9) years].All the TB patients received standard chemotherapy regimen of anti-tuberculosis,and were divided into 2 groups:one completed treatment group (cured or clinically cured 38 cases) and 1 uncompleted treatment group (treatment failure or need to extend treatment,30 cases).Peripheral blood serum at 0,2,6 month during the treatment from 68 tuberculosis patients were collected,and the concentration of IFN-γ,IL-4,IL-17,TGF-β,TNF-α and IL-10 were detected by ELISA tests.Results The concentration of IFN-γ,TGF-β and IL-4 in all enrolled patients showed significant decrease (from 23.2 ng/L to 22.3 ng/L,from 169.1 ng/L to 123.2 ng/L;65.0 ng/L to 31.9 ng/L) (t =2.67,2.35 and 3.41,P ＜ 0.05) along with the extension of treatment.IL-10 increased significantly(12.9 ng/L)in the uncompleted treatment group but declined significantly (5.38 ng/L) (P ＜ 0.05) in the completed treatment group at the end of 6 month.Meanwhile,IL-4 decreased significantly (P ＜ 0.05) in the completed treatment group but no significant changes were observed in the uncompleted treatment group.Th1/Th2 (IFN-γ/IL-4) raised gradually in the completed treatment group (0 month ＜ 2 month ＜ 6 month,t =6.32,6.03 and 5.85,P ＜ 0.05),while it was only at 6 month in the uncompleted treatment group (0 month ＜6 month,t =3.7,P ＜ 0.05).And the ratio of Th1/Th2 in the completed treatment group was significantly higher than that in the uncompleted group treatment(P ＜ 0.05).Conclusion It suggests that the changes of Th1 cytokines (IFN-γ,TGF-β)and the Th1/Th2 balance play an important role in the pathogenesis,development and prognosis of TB.The suppression of IFN-γ,TGF-β or Th1/Th2 balance may be an important factor influencing the prognosis of TB.