肿瘤坏死因子-α和转铁蛋白在肺结核感染中的检测及临床意义

摘要

目的 通过对肺结核患者肿瘤坏死因子-α(NF-α)和转铁蛋白(TRF)水平的联合测定,探讨它们在肺结核感染中的作用和临床意义.方法 选择547例肺结核患者为病例组,72例健康体检者为对照组.病例组按照结核杆菌涂片结果、临床诊断分型、耐药性差异进行进一步分组,综合分析肺结核患者TNF-α和TRF水平的变化.结果 TNF-α和TRF浓度与痰结核分枝杆菌数量呈正相关;病例组TNF-α水平均高于对照组,差别有统计学意义(P＜0.05,P＜0.01);TRF水平均高于对照组,除抗酸杆菌阴性者,其余差别均有统计学意义(P＜0.01).抗酸杆菌阳性者TNF-α水平均高于抗酸杆菌阴性者,差别有统计学意义(P＜0.01);TRF水平抗酸杆菌阳性者均高于抗酸杆菌阴性者,除抗酸杆菌弱阳性者,其余差别均有统计学意义(P＜0.01).继发性肺结核和结核性胸膜炎TNF-α水平明显高于原发性肺结核和血行播散性肺结核(P＜0.01);血行播散性肺结核TRF水平明显高于原发性肺结核、继发性肺结核及结核性胸膜炎(P＜0.01).治疗前,TNF-α和TRF水平在不同耐药者之间差别无统计学意义(P＞0.05);治疗后,不同耐药者TNF-α和TRF水平与治疗前比较均下降,除耐多药结核外,其余差别均有统计学意义(P＜0.01).结论 TNF-α和TRF的测定对研究结核杆菌致病机制、抗结核治疗疗效观察及耐药性的产生机制具有重要的研究价值.%Objective To simultaneous detect serum concentration of tumor necrosis factor-alpha(TNF-ct) and trans-ferrin(TRF) ,in order to explore their effects and clinical significance in patients with tuberculosis infection. Methods Five hundred and forty-seven cases with pulmonary tuberculosis and 72 cases of healthy individuals were selected as disease group and control group, respectively. The patients in disease group were divided into different groups according to the results of tubercle bacillus smear,clinical diagnosis classification and difference of drug tolerance. The changes of TNF-a and TRF in different groups were detected and comprehensive analyzed. Results TNF-a and TRF concentrations were positively correlated with the number of Mycobacterium tuberculosis in sputum. Compared with control group,the TNF-a level in disease group was higher (P<0.05,P<0. 01); the TRF level was higher, there was statistical significance except the patients with negative acid-fast bacillus(P <0. 01). In disease group,the TNF-a levels in patients with positive acid-fast bacillus were higher than the patients with negative acid-fast bacillus (P<0.01) ;the TRF levels in patients with positive acid-fast bacillus were higher than the patients with negative acid-fast bacillus,there were statistical significance except the patients with weakly positive acid-fast bacillus( P <0. 01). The TNF-a levels in patients with secondary pulmonary tuberculosis and tuberculous pleuritis were higher than primary tuberculosis and hematogenous disseminated pulmonary tuberculosis(P<0.01) ;the TRF levels in patients with hematogenous disseminated pulmonary tuberculosis were higher than primary tuberculosis, secondary pulmonary tuberculosis and tuberculous pleuritis( P <0.01). The TNF-a and TRF levels in patients with different drug tolerance group were no statistical significance before treatment(P>0.05). After treatment,the TNF-a and TRF levels in different drug tolerance group decreased, except multiple drug resistance pulmonary tuberculosis, there were statistical significance ( P < 0.01). Conclusion Determination of TNF-a and TRF have important value in researching pathogenesis about tuberculosis bacilli, observation ofcurative effect about anti-tuberculosis drug treatment and generating mechanism about drug resistance.