支气管肺泡灌洗液和血清中TGF-β IFN-γ水平与特发性肺纤维化的关系

doi:10.3969/j.issn.1006-6233.2021.05.013

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摘要 目的: 分析支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)和血清中转化生长因子-β(transforming growth factor-β,TGF-β)、γ干扰素(interferon-γ,IFN-γ)水平与特发性肺纤维化(idiopathic pulmonary fibrosis,IPF)的关系。方法: 回顾性分析2016年2月至2019年12月135例IPF患者临床资料,收集患者入院24h内BALF及血清标本,根据呼吸困难评分(modified Medical Research Council,mMRC)分为轻度组、中重度组,比较两组BALF及血清TGF-β、IFN-γ水平差异,分析BALF及血清TGF-β、IFN-γ水平与病情严重程度的相关性;并根据135例IPF患者临床疗效分为有效组及无效组,使用受试者工作特征曲线(receiver operating characteristic curve,ROC)评估BALF及血清TGF-β、IFN-γ水平对治疗有效的预测价值。结果: 两组性别、年龄、病程比较,差异无统计学意义(P>0.05);轻度组磨玻璃影及间质纤维化评分均低于中重度组(P<0.05),且轻度组BALF及血清TGF-β水平低于中重度组(P<0.05),BALF及血清IFN-γ水平高于中重度组(P<0.05)。经Pearson相关性分析,发现BALF及血清TGF-β水平与mMRC、磨玻璃影、间质纤维化评分均呈显著正相关(P<0.05),BALF及血清IFN-γ水平与mMRC、磨玻璃影、间质纤维化评分均呈显著负相关(P<0.05)。135例IPF患者治疗无效29例(21.48%),有效106例(78.52%),无效组BALF及血清TGF-β水平均高于有效组(P<0.05),无效组BALF及血清IFN-γ水平低于有效组(P<0.05);经ROC曲线分析,发现BALF及血清TGF-β、IFN-γ水平均对诊断IPF患者治疗有效有利(AUC=0.733、0.718、0.735、0.796,P<0.05),其截断值为958.42ng/L、229.14ng/L、1009.37ng/L、250.87ng/L。结论: 入院早期BALF及血清TGF-β、IFN-γ水平不仅与IPF病情严重相关,还能辅助预测患者治疗有效状况,对指导临床治疗有利。

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关键词 ：特发性肺纤维化, 支气管肺泡灌洗液, 血清, TGF-β, IFN-γ

Abstract：Objective: To analyze the relationship between levels of transforming growth factor-β (TGF-β) and interferon-γ (IFN-γ) in bronchoalveolar lavage fluid (BALF) and serum and idiopathic pulmonary fibrosis (IPF). Methods: The clinical data of 135 patients with IPF from February 2016 to December 2019 were retrospectively analyzed. BALF and serum samples were collected within 24 h after admission. According to the modified Medical Research Council (mMRC) dyspnea score, the patients were divided into mild group and moderate-to-severe group, and the levels of TGF-β and IFN-γ in BALF and serum were compared between the two groups, and the correlation between levels of TGF-β and IFN-γ in BALF and serum and the severity of disease was analyzed. 135 patients with IPF were divided into effective group and ineffective group based on the clinical efficacy. Receiver operating characteristic curve (ROC curve) was used to assess the predictive value of levels of TGF-β and IFN-γ in BALF and serum on effective treatment. Results: There were no significant differences in gender, age and course of disease between the two groups (P>0.05). The scores of ground glass opacity and interstitial fibrosis in mild group were lower than those in moderate-to-severe group (P<0.05), and the levels of TGF-β in BALF and serum in mild group were lower than those in moderate-to-severe group (P<0.05) while the levels of IFN-γ in BALF and serum were higher than those in moderate-to-severe group (P<0.05). Pearson correlation analysis showed that TGF-β levels in BALF and serum were significantly positively correlated with scores of mMRC, ground glass opacity and interstitial fibrosis (P<0.05), and IFN-γ levels in BALF and serum were significantly negatively correlated with scores of mMRC, ground glass opacity and interstitial fibrosis (P<0.05). Among 135 patients with IPF, there were 29 cases (21.48%) with ineffective treatment and 106 cases (78.52%) with effective treatment. The levels of TGF-β in BALF and serum in ineffective group were higher than those in effective group (P<0.05) while the levels of IFN-γ in BALF and serum in ineffective group were lower than those in effective group (P<0.05). After ROC curve analysis, it was found that levels of TGF-β and IFN-γ in BALF and serum were effective and beneficial for the treatment and diagnosis of patients with IPF (AUC=0.733, 0.718, 0.735, 0.796, P<0.05), and the cut-off values were 958.42 ng/L, 229.14 ng/L, 1009.37 ng/L and 250.87 ng/L. Conclusion: The levels of early TGF-β and IFN-γ in BALF and serum after admission are not only related to the severity of IPF, but can also assist in predicting the effective treatment status of patients, and they are beneficial for guiding clinical treatment.

Key words： Idiopathic pulmonary fibrosis Bronchoalveolar lavage fluid Serum TGF-β IFN-γ

基金资助:四川省卫生和计划生育委员会科研课题,(编号:17PJ051)

引用本文:

罗立, 熊沿, 王慧, 张剑, 聂晓红. 支气管肺泡灌洗液和血清中TGF-β IFN-γ水平与特发性肺纤维化的关系[J]. 河北医学, 2021, 27(5): 762-767.
LUO Li, XIONG Yan, et al. Relationship Between Levels of TGF-β and IFN-γ in Bronchoalveolar Lavage Fluid and Serum and Idiopathic Pulmonary Fibrosis. HeBei Med, 2021, 27(5): 762-767.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2021.05.013 或 http://www.hbyxzzs.cn/CN/Y2021/V27/I5/762

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