Abstract:Objective: To observe the correlation between serum interleukin-15 (IL-15), α1-acid glycoprotein (AAG) and prognosis of patients with pulmonary tuberculosis after chemotherapy, to guide the clinical rational evaluation of prognosis and intervention of patients with ulmonary tuberculosis after chemotherapy. Methods: A total of 221 patients with pulmonary tuberculosis admitted to our hospital from February 2017 to February 2019 were selected as the research subjects, and the baseline data of patients were collected by self-made questionnaire of our hospital. All patients received chemotherapy, and after 2 months of treatment, the levels of cytokines [interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), macrophage migration inhibitory factor (MIF) and IL-15] and AAG were detected. The status of sputum smear having turned negative was recorded after 8 months of treatment. The prognosis of the patients was evaluated by chest X-ray examination. The patients were divided into poor prognosis group (n=69) and good prognosis group (n=152). The baseline data, cytokine levels and AAG levels of the two groups were compared, and the relationship between serum AGG level and each indicator and prognosis of patients was analyzed. Results: After 8 months of treatment, 152 of 221 patients with pulmonary tuberculosis had a good prognosis and 69 had a poor prognosis. After comparing the baseline data, cytokine levels and AAG levels between the good prognosis group and the poor prognosis group, the indicators with statistically significant differences were taken as independent variables, and the prognosis of patients was a dependent variable. Multiple regression model was established, and the results showed that the over expression of IFN-γ, TNF-α, MIF, IL-15 and down-regulation of AAG were all risk factors of poor prognosis in patients with pulmonary tuberculosis treated with chemotherapy for 2 months (OR>1, P<0.05). The receiver operating curve (ROC) was plotted and revealed that IFN-γ, TNF-α, MIF, IL-15 and AAG levels predicted the area under the curve (AUC) of the risk of poor prognosis were >0.71, all had certain predictive value. The highest AUC was predicted by AAG. Conclusion: The risk of poor prognosis in patients with pulmonary tuberculosis chemotherapy is high, which is related to the abnormal expression of IFN-γ, TNF-α, MIF, IL-15 and AAG after 2 months of treatment, of which the expression level of IL-15 and AAG has higher predictive value on the prognosis of patients with pulmonary tuberculosis after chemotherapy. The test results during treatment can guide the prognosis risk prediction and reasonable adjustment of treatment plan.
[1] 刘倩倩,欧勤芳,高岩,等.碱性亮氨酸拉链ATF样蛋白调控结核免疫发病机制的初步研究[J].中华传染病杂志,2017,35(6):321~325. [2] 刘杰,韩冬会,韩志勇.左氧氟沙星方案对肺结核患者痰转阴、不良反应及生存质量的影响[J].中国地方病防治杂志,2017,32(4):395. [3] Godfrey M S,Friedman L N.Tuberculosis and biologic therapies:anti-tumor necrosis factor-α and beyond[J].Clin Chest Med,2019,40(4):721~739. [4] Shang Z B,Wang J,Kuai S G,et al.Serum macrophage migration inhibitory factor as a biomarker of active pulmonary tuberculosis[J].Ann Lab Med,2018,38(1):9~16. [5] Kim J Y,Park J H,Kim M C,et al.Combined IFN-γ and TNF-α release assay for differentiating active tuberculosis from latent tuberculosis infection[J].Infect,2018,77(4):314~320. [6] 刘冰靥,王德成,范小勇.白细胞介素7与15在抗结核感染中的作用及应用[J].中国防痨杂志,2018,40(4):425~428. [7] Ajmal N R,Almutairi F,Zaidi N,et al.Biophysical insights into the interaction of clofazimine with human alpha 1-acid glycoprotein:a multitechnique approach[J].Biomol Struct Dyn,2019,37(6):1390~1401. [8] Ceciliani F,Lecchi G.The immune functions of α 1 acid glycoprotein[J].Curr Protein Pept Sci,2019,20(6):505~524.