目的：探讨活动性肺结核患者抗结核治疗后血清不同炎症因子的水平改变。方法连续性随机选取自150例肺结核患者,分别于抗结核治疗前,治疗后2、4、6个月共四个时间点检测促炎因子( IL-12, IFNγ,TNFα,IL-1β以及Il-6)和抗炎因子(IL-10,TGFβ以及IL-4)的水平变化。综合分析促炎因子和抗炎因子水平动态变化与抗结核疗效和临床预后的关系。结果肺结核组患者,治疗前IL-12,IFNγ,TNFα,IL-1β以及Il-6水平均高于对照组(P<0．05)。经过治疗后,IFNγ和IL-6明显下降(P<0．05)。肺结核组患者治疗前TGFβ以及IL-4水平均低于对照组(P<0．05),经过治疗后TGFβ明显上升(P<0．05)。相关性分析可见, IL-1β和IL-4与BMI呈负相关(P<0．05),TNFα与痰涂片细菌数量呈负相关(P<0．05),IL12与INFγ呈正相关(P<0．05),IL-6与IL-1β和TNFα(P<0．05)呈负相关。通过ROC曲线分析提示治疗前INFγ和IL-6均有中等诊断学意义(INFγ： AUC =0．768,P =0．041； IL-6： AUC =0．768,P =0．041)。结论肺结核患者血清INFγ、IL-6和TGFβ水平在治疗过程中动态变化,与病情发展和临床预后转归密切相关,是潜在评价抗结核疗效的标记物。%Objective To study the changes of serum inflammatory cytokines in patients with active pulmo-nary tuberculosis after anti-tuberculosis drug therapy. Methods 150 patients with active pulmonary tuberculosis were enrolled in this study. The serum levels of pro-inflammatory factors (IL-12, IFNγ, TNFα, IL-1β and IL-6) and anti-inflammatory cytokines (IL-10, TGFβ and IL-4) were measured before and 2, 4 and 6 months after treat-ment. Results The levels of IL-12, IFNγ, TNFα, IL-1βand IL-6 were significantly higher in the TB group than in the control group (P<0. 05). The levels of IFNγ and IL-6 decreased significantly after the treatment (P<0. 05). The levels of TGFβand IL-4 were significantly lower in the TB group before the treatment, while the conten of TGFβdecreased significantly after the treatment ( P<0. 05 ) . Correlation analysis showed that IL-1β and IL-4 were nega-tively associated with BMI (P<0. 05) and the level of TNFαwas negatively associated with sputum bacteria analysis (P<0. 05). ROC analysis showed the levels of INFγ and IL-6 before treatment had a moderate diagnosis value (INFγ:AUC=0. 768, P=0. 041;IL-6:AUC=0. 768, P=0. 041). Conclusion The levels of IFNγ, IL-6 and TGFβ are dynamic variation in TB patients and significantly associated with therapeutic effect and clinical prognosis, which may be the promising potential biomarkers in evaluation of TB treatment.
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