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目的研究活动性肺结核和细菌性肺炎及原发性支气管肺癌患者的外周血单个核细胞(PBMCs)经结核分枝杆菌特异性抗原肽刺激后的多因子表达特点及诊断意义。方法 100例初治活动性肺结核患者,35例细菌性肺炎和原发性支气管肺癌患者,分离外周血单个核细胞(PBMCs),用结核分枝杆菌特异性抗原肽刺激,采用FlowCytomix流式技术检测细胞培养液上清上中IFN-γ、TNF-α、IL-2、IP-10(CXCL10)和MIG(CXCL9)的表达,用接受者工作特征曲线(ROC curve)评价以上结核分枝杆菌抗原特异反应性因子的诊断价值。结果 PBMCs经结核分枝杆菌特异性抗原肽刺激后,培养液上清中IFN-γ、TNF-α、IL-2、IP-10和MIG水平显著升高,初治活动性肺结核患者与其他肺病对照组差别显著(中位值分别为595.0/0.0 pg/ml,338.0/48.6 pg/ml,226.0/0.0 pg/ml,3 865.0/297.0 pg/ml,3541.0/81.1 pg/ml;P值均<0.000 1),ROC曲线下面积(95%CI)分别为0.917 1(0.862 9~0.971 4),0.807 0(0.724 6~0.889 4),0.854 9(0.785 5~0.924 2),0.920 0(0.870 8~0.969 2),0.936 3(0.894 4~0.978 1),IFN-γ诊断特异性为94.3%,联合IP-10诊断提高敏感性至92.1%。结论结核分枝杆菌特异性抗原肽刺激外周血单个核细胞产生的MIG、IP-10和IFN-γ能够良好的鉴别初治活动性肺结核及常见的细菌性肺炎和原发性支气管肺癌,可能成为新的诊断指标。
Objective To investigate the multi-factor expression of peripheral blood mononuclear cells (PBMCs) from patients with active pulmonary tuberculosis and bacterial pneumonia and primary bronchial lung cancer after being stimulated by Mycobacterium tuberculosis specific antigen peptide and its diagnostic significance. Methods Peripheral blood mononuclear cells (PBMCs) were isolated from 100 patients with newly diagnosed active pulmonary tuberculosis and 35 patients with bacterial pneumonia and primary bronchogenic carcinoma. The cells were stimulated with Mycobacterium tuberculosis specific antigen peptide and detected by FlowCytomix flow cytometry Expression of IFN-γ, TNF-α, IL-2, IP-10 (CXCL10) and MIG (CXCL9) in cell culture supernatant was evaluated using the receiver operating characteristic curve (ROC curve) for the above Mycobacterium tuberculosis antigen Diagnostic value of specific reactive factors. Results The levels of IFN-γ, TNF-α, IL-2, IP-10 and MIG in the culture supernatants were significantly increased after PBMCs were stimulated with Mycobacterium tuberculosis specific antigen peptide. The newly diagnosed active tuberculosis patients were significantly associated with other lung diseases The control group had significant difference (median value of 595.0 / 0.0 pg / ml, 338.0 / 48.6 pg / ml, 226.0 / 0.0 pg / ml, 3865.0 / 297.0 pg / ml and 3541.0 / 0.000 1). The area under the ROC curve (95% CI) was 0.917 1 (0.862 9 ~ 0.971 4), 0.807 0 (0.724 6 ~ 0.889 4), 0.854 9 (0.785 5 ~ 0.924 2) and 0.920 0 (0.870 8 ~ 0.969 2), 0.936 3 (0.894 4 ~ 0.978 1). The diagnostic specificity of IFN-γ was 94.3%. The sensitivity of combined IP-10 diagnosis was 92.1%. Conclusions MIG, IP-10 and IFN-γ produced by peripheral blood mononuclear cells stimulated by Mycobacterium tuberculosis specific antigen peptide can distinguish newly diagnosed active pulmonary tuberculosis and common bacterial pneumonia and primary bronchogenic lung cancer, and may be New diagnostic indicator.