2024 年第 10 期 第 19 卷

CD+4/CD+8比值联合细胞因子对活动性与非活动性肺结核的鉴别价值

The differential value of CD+4/CD+8 ratio combined with cytokines in active and inactive pulmonary tuberculosis

作者：田二朋马伟立刘美齐亚楠

英文作者：Tian Erpeng Ma Weili Liu Mei Qi Yanan

单位：河北省胸科医院分子生物学实验室河北省肺病重点实验室，石家庄050000

英文单位：Laboratory of Molecular Biology Hebei Chest Hospital Hebei Key Laboratory of Lung Disease Shijiazhuang 050000 China

关键词：活动性肺结核；细胞因子；细胞免疫；相关性；交互作用

英文关键词：Activepulmonarytuberculosis;Cytokines;Cellularimmunity;Relativity;Interaction

• 摘要：

• 目的 探讨CD+4/CD+8比值联合细胞因子对活动性与非活动性肺结核的鉴别价值。方法 选择2021年1月至2023年8月河北省胸科医院收治的107例肺结核患者作为研究对象。根据病情将患者分为非活动性肺结核组（53例）和活动性肺结核组（54例）。比较2组患者血清细胞因子水平及CD+4/CD+8比值；分层回归分析肺结核患者血清细胞因子水平与CD+4/CD+8比值的关系；多因素Logistic回归方法分析影响活动性肺结核发生的因素；分析血清细胞因子与CD+4/CD+8比值的交互作用对活动性肺结核发生的影响；采用受试者工作特征（ROC）曲线评价血清细胞因子、CD+4/CD+8比值单独及联合对活动性与非活动性肺结核的鉴别价值。结果 活动性肺结核组血清IL-6、γ干扰素、IL-8、CD+4/CD+8比值水平均明显高于非活动性肺结核组，差异均有统计学意义（均P＜0.05）。分层回归分析结果显示，IL-6、γ干扰素、IL-8均对CD+4/CD+8比值产生显著的正向影响（均P＜0.05）；多因素Logistic回归分析结果显示，血清IL-6、γ干扰素、IL-8水平升高、CD+4/CD+8比值增加是活动性肺结核发生的危险因素（均P＜0.05）；交互作用分析结果显示，校正性别、年龄前后，血清IL-6、γ干扰素、IL-8分别与CD+4/CD+8比值均不存在相乘和相加交互作用（均P＞0.05）。IL-6、γ干扰素、IL-8、CD+4/CD+8比值及四者联合的ROC曲线下面积分别为0.746、0.771、0.805、0.707和0.850，四者联合对活动性与非活动性肺结核的鉴别效能最高。结论 活动性肺结核患者血清IL-6、γ干扰素、IL-8水平及外周血CD+4/CD+8比值较非活动性肺结核患者升高，血清细胞因子水平影响肺结核患者细胞免疫状态，据此可对活动性与非活动性肺结核进行鉴别。

• Objective To discuss the differential value of CD+4/CD+8 ratio combined with cytokines in active and inactive pulmonary tuberculosis. Methods Totally 107 patients with pulmonary tuberculosis treated in Hebei Chest Hospital from January 2021 to August 2023 were selected as research objects. They were divided into inactive pulmonary tuberculosis group(53 cases) and active pulmonary tuberculosis group(54 cases) according to the condition. The levels of serum cytokines and CD+4/CD+8 ratio were compared between the two groups. The relationship between serum cytokine level and CD+4/CD+8 ratio in patients with pulmonary tuberculosis was analyzed by stratified regression analysis. Multivariate Logistic regression analysis was used to analyze the factors affecting the occurrence of active pulmonary tuberculosis. The effect of the interaction between serum cytokines and CD+4/CD+8 ratio on the occurrence of active pulmonary tuberculosis was analyzed. The receiver operating characteristic (ROC) curve was used to evaluate the value of serum cytokines and CD+4/CD+8 ratio alone and in combination in the differential diagnosis of active and inactive pulmonary tuberculosis. Results The levels of serum interleukin-6(IL-6), interferon-γ(INF-γ), IL-8 and CD+4/CD+8 ratio in active pulmonary tuberculosis group were significantly higher than those in inactive pulmonary tuberculosis group(all P<0.05). The results of stratified regression analysis showed that IL-6, INF-γ and IL-8 all had significant positive effects on CD+4/CD+8 ratio(all P<0.05). The results of multivariate Logistic regression analysis showed that the increased levels of serum IL-6, INF-γ, IL-8 and CD+4/CD+8 ratio were the risk factors of active pulmonary tuberculosis(all P<0.05). The results of interaction analysis showed that there was no multiplicative or additive interaction between serum IL-6, INF-γ, IL-8 and CD+4/CD+8 ratio before and after adjusting sex and age(all P>0.05). The areas under the ROC curve of IL-6, INF-γ, IL-8, CD+4/CD+8 ratio and their combination were 0.746, 0.771, 0.805, 0.707 and 0.850, respectively, the combination of the four has the highest efficacy in distinguishing active and inactive pulmonary tuberculosis. Conclusion The levels of serum IL-6, INF-γ, IL-8 and peripheral blood CD+4/CD+8 ratio in patients with active pulmonary tuberculosis were higher than those in patients with inactive pulmonary tuberculosis. The level of serum cytokines can affect the cellular immunity of patients with pulmonary tuberculosis, based on this, active and inactive pulmonary tuberculosis can be distinguished.