Losada Paula Ximena, Perdomo-Celis Federico, Castro Marcela, Salcedo Carol, Salcedo Arnold, DeLaura Isabel, Lastra Giovani, Narváez Carlos F
Programa de Medicina, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia.
Programa de Medicina, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia; Sección de Neumología, Departamento de Medicina Interna, Hospital Universitario de Neiva, Neiva, Huila, Colombia.
Cytokine. 2020 Mar;127:154950. doi: 10.1016/j.cyto.2019.154950. Epub 2019 Dec 25.
Pulmonary tuberculosis (PTB) has been identified as a substantial public health threat and diagnostic challenge. A large proportion of patients exhibit negative smear tests despite active infection. The role of cytokines in the pathophysiology and clinical severity of PTB remains a controversial question. We evaluated the pattern of cytokines presents locally in patients with smear-negative PTB. Levels of tumor necrosis factor (TNF)-α, interferon (IFN)-γ, interleukin (IL)-2, IL-4, IL-6, IL-10, and IL-17 in bronchoalveolar lavage fluid (BALf) from patients with smear-negative PTB, as well as in those with other pulmonary diseases and controls, were performed by flow cytometry. ROC curve and a radiological severity scale were used to establish the potential diagnosis use and the relationship of the cytokine levels with disease severity, respectively. The levels of IL-6 were higher in the PTB (P = 0.0249) and pneumonia (P = 0.0047) groups compared to controls. Low to undetectable levels of TNF-α, IFN-γ, IL-2, IL-4, IL-10, and IL-17 were found in BALf, even after sample concentration using filtration columns and centrifugation. IL-6 levels measured in BALf could distinguish PTB patients or pneumonia patients from controls (AUC: 0.91, P = 0.002 and AUC: 0.86, P = 0.001, respectively), but not patients with PTB from those with pneumonia (AUC: 0.51, P = 0.86). IL-6 levels were related with the severity of PTB, as levels were higher in patients with higher radiological severity. These results confirm the importance of IL-6 in the immunopathology of smear-negative PTB.
肺结核（PTB）已被确认为对公众健康构成重大威胁且是一项诊断挑战。尽管存在活动性感染，但很大一部分患者痰涂片检测呈阴性。细胞因子在PTB病理生理学和临床严重程度中的作用仍是一个有争议的问题。我们评估了痰涂片阴性PTB患者局部存在的细胞因子模式。通过流式细胞术检测了痰涂片阴性PTB患者、其他肺部疾病患者及对照组支气管肺泡灌洗液（BALf）中肿瘤坏死因子（TNF）-α、干扰素（IFN）-γ、白细胞介素（IL）-2、IL-4、IL-6、IL-10和IL-17的水平。分别使用ROC曲线和放射学严重程度量表来确定细胞因子水平在潜在诊断中的用途以及与疾病严重程度的关系。与对照组相比，PTB组（P = 0.0249）和肺炎组（P = 0.0047）中IL-6水平更高。即使使用过滤柱和离心对样本进行浓缩后，在BALf中仍发现TNF-α、IFN-γ、IL-2、IL-4、IL-10和IL-17水平较低或无法检测到。在BALf中测得的IL-6水平可将PTB患者或肺炎患者与对照组区分开来（AUC分别为0.91，P = 0.002和0.86，P = 0.001），但无法区分PTB患者与肺炎患者（AUC为0.51，P = 0.86）。IL-6水平与PTB的严重程度相关，因为在放射学严重程度较高的患者中IL-6水平更高。这些结果证实了IL-6在痰涂片阴性PTB免疫病理学中的重要性。
