摘要
目的探讨外周血Toll样受体2(TLR2)mRNA和辅助性T淋巴细胞(Th)1/Th2/Th17细胞因子水平对耐多药肺结核(MDR-TB)患者预后的关系。方法选取2021年11月至2023年5月重庆市九龙坡区人民医院就诊的30例MDR-TB患者、30例药物敏感性结核病(DS-TB)患者和30例结核菌素纯蛋白衍生物试验阳性(purified protein derivative^(+),PPD^(+))的健康者作为研究对象。荧光定量PCR测定3组外周血TLR2 mRNA水平,流式细胞术检测3组外周血的CD4细胞比例、T-bet^(+)CD4^(+)细胞比例、白细胞介素(IL)-4、IL-17、干扰素γ(IFN-γ)水平。多因素Logistic回归分析影响MDR-TB患者预后的因素。结果PPD^(+)组CD4细胞比例和IFNγ水平显著高于DS-TB组和MDR-TB组,而PPD^(+)组IL-4、IL-17和TLR2 mRNA低于DS-TB组和MDR-TB组,差异有统计学意义(P<0.05)。MDR-TB预后良好组CD4细胞比例和IFN-γ水平显著高于预后不良组,而IL-4、IL-17和TLR2 mRNA水平显著低于预后不良组,差异有统计学意义(P<0.05)。CD4细胞比例增加和IFN-γ水平升高是MDR-TB患者预后的保护因素,IL-4、IL-17和TLR2 mRNA水平升高是MDR-TB患者预后的危险因素(P<0.05)。结论外周血中高表达TLR2 mRNA、IL-4及IL-17是MDR-TB患者预后的危险因素,高水平的CD4细胞比例、IFN-γ是MDR-TB患者预后的保护因素,监测外周血中TLR2 mRNA、IL-4、IL-17和IFN-γ水平对于判断MDR-TB患者预后有一定的临床价值。
Objective To investigate the relationship between the peripheral blood Toll-like receptor 2(TLR2)mRNA expression,T helper cell(Th)1/Th2/Th17 cytokine changes,and prognosis in multidrug-resistant tuberculosis(MDR-TB)patients.Methods A total of 30 MDR-TB patients,30 drug-susceptible tuberculosis(DS-TB)patients,and 30 healthy individuals with positive tuberculin pure protein derivative(PPD^(+))test results were included from November 2021 to May 2023.TLR2 mRNA levels in peripheral blood were detected by fluorescence quantitative PCR.Flow cytometry was used to measure CD4 cell ratio,T-bet^(+)CD4^(+)cell ratio,interleukin-4(IL-4),IL-17,and interferon-γ(IFN-γ)levels.Multivariate Logistic regression analysis was conducted to identify factors influencing MDR-TB prognosis.Results The CD4 cell ratio and IFN-γlevels in the PPD^(+)group were significantly higher than those in the DS-TB and MDR-TB groups,while the IL-4,IL-17,and TLR2 mRNA levels were significantly lower(P<0.05).In MDR-TB patients,the CD4 cell ratio and IFN-γlevels in the good prognosis group were significantly higher than those in the poor prognosis group,while IL-4,IL-17,and TLR2 mRNA levels were significantly lower(P<0.05).Increased CD4 cell ratio and IFN-γlevels were protective factors,while elevated IL-4,IL-17,and TLR2 mRNA levels were risk factors for poor prognosis(P<0.05).Conclusion High expression levels of TLR2 mRNA,IL-4,and IL-17 in peripheral blood are risk factors for poor prognosis in MDR-TB patients,while high CD4 cell ratio and IFN-γlevels serve as protective factors.Monitoring these biomarkers may have clinical significance in evaluating the prognosis of MDR-TB.
作者
程小会
唐铮
李欣芹
李飞
李洁
余雷
林青
CHENG Xiaohui;TANG Zheng;LI Xinqin;LI Fei;LI Jie;YU Lei;LIN Qing(Department of Infectious Diseases,Jiulongpo District People's Hospital,Chongqing 400050,China;Chongqing Medical University,Chongqing 400016,China)
出处
《转化医学杂志》
2024年第10期1651-1655,共5页
Translational Medicine Journal
基金
重庆市自然科学基金面上项目(cstc2020jcyjmsxmX0715)
重庆市九龙坡区公共卫生重点学科和实验室建设经费资助(JLPWBF202363)。
