血清γ-干扰素、白细胞介素2和白细胞介素6水平在60岁及以上老年肺结核患者中的表达及其临床价值

doi:10.19982/j.issn.1000-6621.20260038

摘要/Abstract

摘要：

目的: 评价血清γ-干扰素(IFN-γ)、白细胞介素2(IL-2)和白细胞介素6(IL-6)单独及联合检测在老年肺结核患者中的表达水平及其辅助诊断价值。方法: 采用回顾性研究方法,参照入组标准收集2023—2025年兰州市肺科医院收治的475例60岁及以上疑似肺结核患者的临床资料,包括患者一般基线资料、影像学特征、病原学检测、生化检测,以及血清IFN-γ、IL-2、IL-6检测结果,以临床最终诊断为参照标准,将老年患者分为肺结核组和非结核组,比较两组患者血清IFN-γ、IL-2、IL-6表达水平的差异,并评估血清IFN-γ、IL-2、IL-6单独及联合检测对老年肺结核诊断的临床辅助价值。结果: 475例老年患者中,肺结核组234例,非结核组241例。肺结核组患者血清IFN-γ、IL-2、IL-6表达水平[分别为23.14(2.73,95.52)、17.64(1.57,115.05)、19.14(6.85,60.86)pg/ml]均明显高于非结核组[分别为1.29(0.00,5.31)、1.97(0.00,7.46)、7.00(2.18,16.49)pg/ml],差异均有统计学意义(Z值分别为120.866、80.050、31.786,P值均<0.001)。以最终临床诊断为参照标准,血清IFN-γ、IL-2、IL-6单一检测的敏感度分别为59.83%(140/234)、55.56%(130/234)、56.84%(133/234),特异度分别为83.40%(201/241)、84.65%(204/241)、74.69%(180/241),准确率分别为71.79%(341/475)、70.32%(334/475)、65.89%(313/475),受试者工作特征曲线下面积(AUC)分别为0.74、0.71、0.69;联合检测时,IFN-γ+IL-2、IFN-γ+IL-6、IL-2+IL-6、IFN-γ+IL-2+IL-6检测的敏感度分别为58.97%(138/234)、73.93%(173/234)、67.52%(158/234)、77.78%(182/234),特异度分别为90.87%(219/241)、73.86%(178/241)、80.91%(195/241)、83.40%(201/241),准确率分别为75.16%(357/475)、73.89%(351/475)、74.32%(353/475)、80.63%(383/475),AUC值分别为0.76、0.80、0.81、0.83。结论: 老年肺结核患者血清IFN-γ、IL-2、IL-6表达水平均明显高于非结核病患者,三者联合的检测效能明显优于单一检测,可在老年肺结核的临床辅助诊断中发挥最大的临床价值。

关键词: 老年人, 结核,肺, 干扰素类, 白细胞介素类, 诊断

Abstract:

Objective: To evaluate the expression levels of interferon-γ (IFN-γ), interleukin-2 (IL-2) and interleukin-6 (IL-6) in elderly patients with pulmonary tuberculosis, and analyze the diagnostic value of individual and combined detection of these three indicators. Methods: A retrospective study was conducted. Clinical data were collected from 475 suspected elderly pulmonary tuberculosis patients aged ≥60 years admitted to Lanzhou Pulmonary Hospital from 2023 to 2025. The data included baseline data, imaging findings, etiological results, biochemical tests as well as serum IFN-γ, IL-2 and IL-6 results. Subjects were divided into pulmonary tuberculosis group and non-tuberculosis group based on final clinical diagnosis. Difference in expression levels of the three cytokines between two groups were compared, and the clinical auxiliary value of detecting serum IFN-γ, IL-2, and IL-6 individually or in combination for diagnosing elderly pulmonary tuberculosis was evaluated. Results: Among 475 elderly subjects, 234 were clinically diagnosed with pulmonary tuberculosis and 241 were non-tuberculosis patients. Serum expression levels of IFN-γ (23.14 (2.73, 95.52) pg/ml), IL-2 (17.64 (1.57, 115.05) pg/ml) and IL-6 (19.14 (6.85, 60.86) pg/ml) in tuberculosis group were significantly higher than those in non-tuberculosis group (1.29 (0.00, 5.31), 1.97 (0.00, 7.46), 7.00 (2.18, 16.49) pg/ml), with statistically significant differences (Z=120.866, 80.050, 31.786, Ps<0.001). The sensitivities of single testing for IFN-γ, IL-2 and IL-6 were 59.83% (140/234), 55.56% (130/234) and 56.84% (133/234), specificities were 83.40% (201/241), 84.65% (204/241) and 74.69% (180/241), accuracies were 71.79% (341/475), 70.32% (334/475) and 65.89% (313/475), and corresponding AUC values were 0.74, 0.71 and 0.69 respectively. For combined testing, the sensitivities of IFN-γ+IL-2, IFN-γ+IL-6, IL-2+IL-6 and three-marker panel were 58.97% (138/234), 73.93% (173/234), 67.52% (158/234) and 77.78% (182/234). Their specificities were 90.87% (219/241), 73.86% (178/241), 80.91% (195/241) and 83.40% (201/241), and their accuracies were 75.16% (357/475), 73.89% (351/475), 74.32% (353/475) and 80.63% (383/475). AUC values were 0.76, 0.80, 0.81 and 0.83, respectively. Conclusion: The serum expression levels of IFN-γ, IL-2, and IL-6 in elderly patients with pulmonary tuberculosis were significantly higher than those in non-tuberculosis patients. The combined testing of three markers demonstrated markedly superior diagnostic performance compared to single testing, offering significant clinical value for the auxiliary diagnosis of elderly pulmonary tuberculosis cases.

Key words: Aged, Tuberculous, pulmonary, Interferons, Interleukin, Diagnosis

中图分类号:

R521

魏黛珏, 邓明坤, 陈彦, 杨增伟, 同重湘. 血清γ-干扰素、白细胞介素2和白细胞介素6水平在60岁及以上老年肺结核患者中的表达及其临床价值[J]. 中国防痨杂志, 2026, 48(8): 1170-1175. doi: 10.19982/j.issn.1000-6621.20260038

Wei Daijue, Deng Mingkun, Chen Yan, Yang Zengwei, Tong Chongxiang. Serum expression levels and clinical value of IFN-γ, IL-2 and IL-6 in elderly pulmonary tuberculosis patients aged 60 years and older[J]. Chinese Journal of Antituberculosis, 2026, 48(8): 1170-1175. doi: 10.19982/j.issn.1000-6621.20260038

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特征	肺结核组(234例)	非结核组(241例)	χ²值	P值
性别			2.788	0.096
男性	124(52.99)	146(60.58)
女性	110(47.01)	95(39.42)
年龄组(岁)			0.833	0.643
60~69	109(46.58)	102(42.32)
70~79	91(38.89)	102(42.32)
≥80	34(14.53)	37(15.36)
体质量指数(kg/m²)			1.071	0.585
<18.5	38(16.24)	32(13.28)
18.5~23.9	133(56.84)	137(56.85)
≥24.0	63(26.92)	72(29.87)

检测方法	临床诊断		敏感度 (%)	特异度 (%)	阳性预测值(%)	阴性预测值(%)	准确率 (%)	约登指数	AUC (95%CI)
检测方法	肺结核	非结核	敏感度 (%)	特异度 (%)	阳性预测值(%)	阴性预测值(%)	准确率 (%)	约登指数	AUC (95%CI)
IFN-γ(pg/ml)			59.83 (140/234)	83.40 (201/241)	77.78 (140/180)	68.14 (201/295)	71.79 (341/475)	0.43	0.74 (0.69~0.78)
≥7	140	40
<7	94	201
IL-2(pg/ml)			55.56 (130/234)	84.65 (204/241)	77.84 (130/167)	66.23 (204/308)	70.32 (334/475)	0.40	0.71 (0.66~0.76)
≥20	130	37
<20	104	204
IL-6(pg/ml)			56.84 (133/234)	74.69 (180/241)	68.56 (133/194)	64.06 (180/281)	65.89 (313/475)	0.31	0.69 (0.65~0.74)
≥7	133	61
<7	101	180
IFN-γ+IL-2			58.97 (138/234)	90.87 (219/241)	86.25 (138/160)	69.52 (219/315)	75.16 (357/475)	0.49	0.76 (0.72~0.81)
	138	22
	96	219
IFN-γ+IL-6			73.93 (173/234)	73.86 (178/241)	73.31 (173/236)	74.48 (178/239)	73.89 (351/475)	0.48	0.80 (0.77~0.84)
	173	63
	61	178
IL-2+IL-6			67.52 (158/234)	80.91 (195/241)	77.45 (158/204)	71.96 (195/271)	74.32 (353/475)	0.48	0.81 (0.77~0.85)
	158	46
	76	195
IFN-γ+IL-2+IL-6			77.78 (182/234)	83.40 (201/241)	81.98 (182/222)	79.45 (201/253)	80.63 (383/475)	0.53	0.83 (0.78~0.86)
	182	40
	52	201