【摘要】 目的 探讨干扰素-γ(IFN-γ)、白细胞介素-10(IL-10)和腺苷脱氨酶(ADA)在活动性肺结核中的诊断价值,并分析IFN-γ、IL-10、ADA水平与其治疗效果的相关性,以期为临床治疗提供参考。方法 选取2020年6月—2022年7月在河北医科大学附属石家庄第五医院治疗的44例活动性肺结核患者作为活动组,40例非活动性肺结核患者作为非活动性肺结核组,另选取同期进行健康体检者38例为健康组。比较3组研究对象入组时IFN-γ、IL-10及ADA水平;分析IFN-γ、IL-10及ADA单独及联合检测(并联试验法)对活动性肺结核的诊断效能;统计活动性肺结核患者治疗6个月时的临床治疗效果;观察不同疗效患者治疗前、后6个月血清IFN-γ、IL-10及ADA水平变化,分析影响活动性肺结核患者治疗效果的相关因素。结果 活动组患者IFN-γ、IL-10及ADA水平均高于非活动组患者和健康组研究对象;非活动组患者IFN-γ、IL-10及ADA水平均高于健康组研究对象,差异均有统计学意义(P<0.05)。IFN-γ、IL-10、ADA联合诊断活动性肺结核灵敏度、特异度、AUC(95%CI)分别为90.00%、89.00%、0.883(0.860～0.905),均高于IFN-γ、IL-10、ADA单独检测活动性肺结核的诊断效能。经治疗后,活动组患者有效36例、无效8例。2组患者病情严重程度分布比较,差异有统计学意义(P<0.05)。治疗前,2组患者IFN-γ、IL-10及ADA水平比较,差异均无统计学意义(P>0.05)。治疗后,2组患者IFN-γ、IL-10及ADA水平均低于治疗前,且有效组低于无效组,差异均有统计学意义(P<0.05)。多元回归分析结果显示:病情程度、IFN-γ、IL-10、ADA水平均为影响活动性肺结核患者疗效的独立影响因素(P<0.05)。结论 活动性肺结核患者中IFN-γ、IL-10、ADA水平升高,有望成为活动性肺结核的鉴别诊断指标,且与活动性肺结核疗效显著相关。因此,动态检测IFN-γ、IL-10、ADA水平对评估疗效有着较高参考价值。更多还原

【Abstract】 Objective To explore the diagnostic effectiveness of serum interferon-γ(IFN-γ), interleukin-10(IL-10), and adenosine deaminase(ADA) in active pulmonary tuberculosis and analyze the correlation between IFN-γ, IL-10, ADA levels and treatment efficacy, aiming to provide a reference for clinical treatment. Methods A total of 44 patients with active pulmonary tuberculosis treated at our hospital from June 2020 to July 2022 were selected as the active group, 40 patients with non-active pulmonary tuberculosis as the non-active group, and 38 healthy individuals undergoing physical examinations during the same period as the healthy group. The levels of IFN-γ, IL-10, and ADA were compared among the three groups at baseline, and the diagnostic efficacy of IFN-γ, IL-10, and ADA alone and in combination(parallel test method) for active pulmonary tuberculosis was analyzed. The clinical treatment effects of patients with active pulmonary tuberculosis after 6 months of treatment were statistically analyzed. Furthermore, the changes in serum IFN-γ, IL-10, and ADA levels before and after 6 months of treatment in patients with different treatment outcomes were observed, and the factors affecting the treatment efficacy of patients with active pulmonary tuberculosis were also analyzed. Results The levels of IFN-γ, IL-10, and ADA in the active group were higher than those in the non-active group and the healthy group; the levels of IFN-γ, IL-10, and ADA in the non-active group were higher than those in the healthy group, with statistically significant differences(P<0.05). The sensitivity, specificity, and AUC(95% CI) of combined diagnosis of IFN-γ, IL-10, and ADA for active pulmonary tuberculosis were 90.00%, 89.00%, and 0.883(0.860-0.905), respectively, which were higher than those of IFN-γ, IL-10, and ADA alone in diagnosing active pulmonary tuberculosis. After treatment, 36 patients in the active group were effective and 8 were ineffective. A statistically significant difference was noted in the distribution of disease severity between the two groups(P<0.05). Before treatment, no statistically significant difference was noted in the levels of IFN-γ, IL-10, and ADA between the two groups(P >0.05). After treatment, the levels of IFN-γ, IL-10, and ADA in both groups showed a decline, and the effective group was lower than the ineffective group, with statistically significant differences(P<0.05). The results of multiple regression analysis showed disease severity and levels of IFN-γ, IL-10, and ADA were independent influencing factors for the treatment efficacy of patients with active pulmonary tuberculosis(P<0.05). Conclusion The levels of IFN-γ, IL-10, and ADA are elevated in patients with active pulmonary tuberculosis and can serve as potential differential diagnostic indicators for active pulmonary tuberculosis, and are significantly correlated with the treatment efficacy of active pulmonary tuberculosis. Therefore, dynamic detection of IFN-γ, IL-10, and ADA levels has a high reference value for evaluating treatment efficacy.更多还原