Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Dis Markers. 2011;31(2):101-10. doi: 10.3233/DMA-2011-0808.
To identify patients at high risk of relapse after anti-tuberculosis (TB) therapy or with poor long-term outcomes.
Fifty-one patients with pulmonary TB: 7 were classified as high association with both cavitations on initial chest radiography and positive sputum smear/cultures after two months of anti-TB treatment (HA group); 19 medium association (MA, one risk alone); and 25 low association (LA, neither risk). Serum interferon (IFN)-γ-inducible protein 10 (IP-10), interleukin-17 (IL-17), and C-reactive protein levels were investigated.
There was a trend towards higher serum IP-10 levels (p=0.042) for HA patients throughout the 6-month treatment period. Month-2 IP-10 levels were higher in the HA than in the MA/LA group (656.2 ± 234.4 vs. 307.6 ± 258.5 pg/ml, adjusted p =0.005). Receiver operating characteristic curves showed that the risk of relapse was well-captured by month-2 IP-10 levels at a cut-off value of 431 pg/ml (AUC=0.857, 95% CI 0.75-0.97, p =0.003). Month-2 serum IL-17 levels were lower in non-survivors than survivors (15.7 ± 2.9 pg/ml vs. 24.6 ± 8.2 pg/ml, p=0.001). Multivariate analysis demonstrated that a month-2 serum IL-17 level of ⩽ 17 pg/ml (p =0.026) was independently associated with all-cause mortality.
Serum IP-10 and IL-17 levels after 2 months of anti-TB treatment may be biomarkers for estimating risk of both cavitation and delayed sputum conversion, and for predicting long-term mortality, respectively.
确定抗结核 (TB) 治疗后复发风险高或长期预后不良的患者。
51 例肺结核患者：7 例被归类为初始胸部 X 射线检查有空洞和抗结核治疗 2 个月后痰涂片/培养阳性的高关联（HA）组；19 例为中关联（MA，有一个风险因素）；25 例为低关联（LA，无风险因素）。检测血清干扰素（IFN）-γ诱导蛋白 10（IP-10）、白细胞介素-17（IL-17）和 C 反应蛋白水平。
在整个 6 个月的治疗期间，HA 患者的血清 IP-10 水平呈升高趋势（p=0.042）。HA 患者的第 2 个月 IP-10 水平高于 MA/LA 组（656.2 ± 234.4 比 307.6 ± 258.5 pg/ml，调整后 p=0.005）。受试者工作特征曲线显示，第 2 个月 IP-10 水平在 431 pg/ml 截值时能很好地捕捉复发风险（AUC=0.857，95%CI 0.75-0.97，p=0.003）。非幸存者的第 2 个月血清 IL-17 水平低于幸存者（15.7 ± 2.9 pg/ml 比 24.6 ± 8.2 pg/ml，p=0.001）。多变量分析表明，第 2 个月血清 IL-17 水平 ⩽17 pg/ml（p=0.026）与全因死亡率独立相关。
抗结核治疗 2 个月后血清 IP-10 和 IL-17 水平可能分别作为估计空洞形成和痰培养延迟转化风险以及预测长期死亡率的生物标志物。
