胸腔积液中IL-27和IFN-γ检测对结核性胸膜炎的诊断价值
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摘要
目的:检测胸腔积液中白细胞介素27 (IL-27)和γ-干扰素(IFN-γ)水平,探讨IL-27和IFN-γ对结核性胸膜炎的诊断价值。方法:选择以胸腔积液就诊的患者88例,按诊断结果分为结核性胸腔积液(TPE)组44例、恶性胸腔积液组20例、类肺炎性胸腔积液组12例和漏出性胸腔积液组12例。检测各组患者胸腔积液中IL-27、IFN-γ和腺苷脱氨酶(ADA)水平,绘制受试者工作特征(ROC)曲线,根据敏感度、特异度和准确度等指标评价其对结核性胸膜炎的诊断价值。结果:TPE组患者胸腔积液中IL-27和IFN-γ水平明显高于其他3组(P<0.05)。胸腔积液中IL-27、IFN-γ和ADA诊断结核性胸膜炎的ROC曲线下面积(AUC)分别为0.96、0.79和0.92,敏感度分别为100.0%、61.4%和78.6%,特异度分别为94.4%、89.5%和92.1%;IL-27、IFN-γ和ADA三者联合检测时,特异度(97.4%)高于单独检测。结论:胸腔积液中IL-27、IFN-γ和ADA检测可作为鉴别结核性胸膜炎的有效方法。单独检测时胸腔积液IL-27对结核性胸膜炎诊断价值高于IFN-γ和ADA,联合检验对诊断结核性胸膜炎具有重要价值。
Objective:To detect the levels of interleukin-27(IL-27)and interferon-γ(IFN-γ)in pleural effusion,and to explore the values of IL-27 and IFN-γin the diagnosis of tuberculous pleuritis.Methods:A total of88 patients with pleural effusion were selected and divided into tuberculous pleural effusion(TPE)group(n=44),malignant pleural effusion group(n=20),parapneumonia pleural effusion group(n=12),and transudative pleural effusion group(n=12).The levels of IL-27,IFN-γand adenosine deaminase(ADA)in pleural effusion of the patients in various groups were detected;the receiver operating characteristic(ROC)curve was drawn to evaluate their diagnostic values for tuberculous pleuritis.Results:The levels of IL-27 and IFN-γin pleural effusion of the patients in TPE group were significantly higher than the other three groups(P<0.05).The areas under ROC curve(AUC)of IL-27,IFN-γand ADA in pleural effusion in diagnosis of tuberculous pleuritis were 0.96,0.79 and0.92,respectively;the specificities were 94.4%,89.5% and 92.1%,respectively;the sensitivities were 100%,61.4% and 78.6%,respectively.The specificity(97.4%)of combined detection of IL-27,IFN-γand ADA was higher than those of single detection.Conclusion:The levels of IL-27,IFN-γand ADA in pleural effusion can be used as an effective method to the differential diagnosis of tuberculous pleuritis.Detection of IL-27 in pleural effusion has a higher diagnostic value for tuberculous pleuritis than IFN-γand ADA.Combined detection of IL-27,IFN-γand ADA has the important value in the diagnosis of tuberculous pleuritis.
Objective:To detect the levels of interleukin-27(IL-27)and interferon-γ(IFN-γ)in pleural effusion,and to explore the values of IL-27 and IFN-γin the diagnosis of tuberculous pleuritis.Methods:A total of88 patients with pleural effusion were selected and divided into tuberculous pleural effusion(TPE)group(n=44),malignant pleural effusion group(n=20),parapneumonia pleural effusion group(n=12),and transudative pleural effusion group(n=12).The levels of IL-27,IFN-γand adenosine deaminase(ADA)in pleural effusion of the patients in various groups were detected;the receiver operating characteristic(ROC)curve was drawn to evaluate their diagnostic values for tuberculous pleuritis.Results:The levels of IL-27 and IFN-γin pleural effusion of the patients in TPE group were significantly higher than the other three groups(P<0.05).The areas under ROC curve(AUC)of IL-27,IFN-γand ADA in pleural effusion in diagnosis of tuberculous pleuritis were 0.96,0.79 and0.92,respectively;the specificities were 94.4%,89.5% and 92.1%,respectively;the sensitivities were 100%,61.4% and 78.6%,respectively.The specificity(97.4%)of combined detection of IL-27,IFN-γand ADA was higher than those of single detection.Conclusion:The levels of IL-27,IFN-γand ADA in pleural effusion can be used as an effective method to the differential diagnosis of tuberculous pleuritis.Detection of IL-27 in pleural effusion has a higher diagnostic value for tuberculous pleuritis than IFN-γand ADA.Combined detection of IL-27,IFN-γand ADA has the important value in the diagnosis of tuberculous pleuritis.
引文
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[19]李嫣红,谢灿茂.Th1/Th2免疫应答系统在结核性胸膜炎患者中的表达[J].中华结核和呼吸杂志,2004,27(5):324-327.
[20]YURT S,KKERGIN C,YIGITBAS B A,et al.Diagnostic utility of serum and pleural levels of adenosine deaminase 1-2,and interferon-γin the diagnosis of pleural tuberculosis[J].Multidiscip Respir Med,2014,9(1):12.
[21]KHAN F Y,HAMZA M,OMRAN A H,et al.Diagnostic value of pleural fluid interferon-gamma and adenosine deaminase in patients with pleural tuberculosis in Qatar[J].Int J Gen Med,2013,6:13-18.
[22]LIANG Q L,SHI H Z,WANG K,et al.Diagnostic accuracy of adenosine deaminase in tuberculous pleurisy:A Metaanalysis[J].Respir Med,2008,102(5):744-754.
[23]WU Y B,YE Z J,QIN S M,et al.Combined detections of interleukin 27,interferon-γ,and adenosine deaminase in pleural effusion for diagnosis of tuberculous pleurisy[J].Chin Med J,2013,126(17):3215-3221.
[24]SKOURAS V S,MAGKOUTA S F,PSALLIDAS I,et al.Interleukin-27improves the ability of adenosine deaminase to rule out tuberculous pleural effusion regardless of pleural tuberculosis prevalence[J].Infect Dis(Lond),2015,47(7):477-483.
[2]CONDE M B,LOIVOS A C,REZENDE V M,et al.Yield of sputum induction in the diagnosis of pleural tuberculosis[J].Am J Respir Crit Care Med,2003,167(5):723-725.
[3]VALDS L,SAN JOSE,FERREIRO L,et al.Interleukin 27could be useful in the diagnosis of tuberculous pleural effusions[J].Respir Care,2014,59(3):399-405.
[4]LIU Q Y,YAN-X,WANG X J,et al.Diagnostic accuracy of interleukin-27 between tuberculous pleural effusion and malignant pleural effusion:A Meta-analysis[J].Respiration,2018,95(6):469-477.
[5]李笑慧.胸水γ-干扰素与腺苷脱氨酶在结核性胸膜炎诊断中的价值[J].医疗装备,2018,31(12):52-53.
[6]王本学,彭丽静,林存智,等.结核性胸膜炎患者196例临床流行病学特点及随访分析[J].中华临床医师杂志:电子版,2014,8(23):4182-4185.
[7]程碧珍,林树勇,张俏忻,等.IL-17与IL-23免疫轴在结核性胸膜炎免疫致病机制中的作用[J].中国校医,2014,28(5):353-355.
[8]葛南海,蔡孝桢,荣蓉,等.Th17和Treg细胞及相关细胞因子在结核性胸膜炎患者中的变化及意义[J].中国实用医药,2016,11(32):46-48.
[9]YOSHIDA H,HAMANO S,SENALDI G,et al.WSX-1is required for the initiation of Th1responses and resistance.major Infection[J].Immunity,2001,15(4):569-578.
[10]ZHANG J D,QIAN X S,NING H,et al.Transcriptional suppression of IL-27 production by Mycobacterium tuberculosis-activated p38 MAPK via inhibition of AP-1binding[J].J Immunol,2011,186(10):5885-5895.
[11]YANG W B,LIANG Q L,YE Z J,et al.Cell origins and diagnostic accuracy of interleukin 27in pleural effusions[J].PLoS ONE,2012,7(7):e40450.
[12]XIA H,YE Z J,ZHOU Q,et al.IL-27and IL-27-producing CD4+T cells in human tuberculous pleural effusion[J].Tuberculosis(Edinb),2014,94(6):579-588.
[13]YE Z J,XU L L,ZHOU Q,et al.Recruitment of IL-27-producing CD4(+)T cells and effect of IL-27on pleural mesothelial cells in tuberculous pleurisy[J].Lung,2015,193(4):539-548.
[14]WANG W,ZHOU Q,ZHAI K,et al.Diagnostic accuracy of interleukin 27 for tuberculous pleural effusion:two prospective studies and one Meta-analysis[J].Thorax,2017,73(3):240-247.
[15]PORCE J M.Advances in the diagnosis of tuberculous pleuritis[J].Ann Transl Med,2016,4(15):282.
[16]LI M,ZHU W Y,KHAN R S U,et al.Accuracy of interleukin-27assay for the diagnosis of tuberculous pleurisy:A PRISMA-compliant meta-analysis[J].Medicine(Baltimore),2017,96(50):e9205.
[17]路晓红,付玉荣,伊正君.IL-27在抗结核分枝杆菌免疫中的作用[J].细胞与分子免疫学杂志,2016,32(3):406-409.
[18]刘伟,李克学.结核性胸膜炎血清和胸水中IL-27的表达及临床意义[J].现代医学与健康研究电子杂志,2017(7):63.
[19]李嫣红,谢灿茂.Th1/Th2免疫应答系统在结核性胸膜炎患者中的表达[J].中华结核和呼吸杂志,2004,27(5):324-327.
[20]YURT S,KKERGIN C,YIGITBAS B A,et al.Diagnostic utility of serum and pleural levels of adenosine deaminase 1-2,and interferon-γin the diagnosis of pleural tuberculosis[J].Multidiscip Respir Med,2014,9(1):12.
[21]KHAN F Y,HAMZA M,OMRAN A H,et al.Diagnostic value of pleural fluid interferon-gamma and adenosine deaminase in patients with pleural tuberculosis in Qatar[J].Int J Gen Med,2013,6:13-18.
[22]LIANG Q L,SHI H Z,WANG K,et al.Diagnostic accuracy of adenosine deaminase in tuberculous pleurisy:A Metaanalysis[J].Respir Med,2008,102(5):744-754.
[23]WU Y B,YE Z J,QIN S M,et al.Combined detections of interleukin 27,interferon-γ,and adenosine deaminase in pleural effusion for diagnosis of tuberculous pleurisy[J].Chin Med J,2013,126(17):3215-3221.
[24]SKOURAS V S,MAGKOUTA S F,PSALLIDAS I,et al.Interleukin-27improves the ability of adenosine deaminase to rule out tuberculous pleural effusion regardless of pleural tuberculosis prevalence[J].Infect Dis(Lond),2015,47(7):477-483.