Objective: To explore the expression levels and clinical significance of helper T cell 1/helper T cell 2 (Th1/Th2) cytokine and interleukin-6 (IL-6) in patients with acute leukemia (AL) complicated by infection.
Methods: 68 patients with AL complicated by infection admitted to Wuhan Fifth Hospital from May 2017 to January 2020 were enrolled as study group, 50 AL patients without infection were enrolled as AL group, and 30 healthy volunteers checked in physical examination center were enrolled as healthy control group. The levels of serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-10 (IL-10), and peripheral blood Th1/Th2 cells subsets were measured and compared among the three groups. The serum IL-6, IL-10, TNF-α and Th1/Th2 were compared between the patients with mild to moderate infection (n=52) and septic shock (n=16). The relationship between IL-6, IL-10, TNF-α, Th1/Th2 and AL infection was analyzed.
Results: The levels of IL-6, IL-10 , TNF-α, and the proportion of Th2 of the patients in study group and AL group were significantly higher than those in healthy control group (P<0.001), while the proportion of Th1 and Th1/Th2 were significantly lower than those in healthy control group (P<0.001). The levels of IL-6, IL-10 and TNF-α, and the proportion of Th2 the patients in study group were significantly higher than those in AL group (P<0.001), while the proportion of Th1 and Th1/Th2 were significantly lower than those in AL group (P<0.001). The serum IL-6, IL-10 and TNF-α level of the patients in septic shock group were significantly higher than those in mild-to-moderate infection group (P<0.001), while Th1/Th2 was lower than those in mild-to-moderate infection group (P<0.001). The results of ROC curve analysis showed that the area under the ROC curve (AUC) values of IL-6, IL-10, TNF-α and Th1/Th2 alone for the diagnosis of septic shock were 0.779, 0.761, 0.724 and 0.718, which were lower than that their combination (0.910) (P<0.05).
Conclusion: The levels of serum IL-6, IL-10 and TNF-α are high in patients with AL complicated infection and septic shock, while Th1/Th2 cell subsets is low. The combined detection of serum IL-6, IL-10, TNF-α and Th1/Th2 is a good diagnostic value for predicting the occurrence of severe septic shock.
题目: 急性白血病感染炎症调节因子的水平及其意义.
目的: 探讨急性白血病（AL）并发感染患者辅助性T细胞1/辅助性T细胞2（Th1/Th2）细胞因子与白介素-6（IL-6）的表达水平及其临床意义.
方法: 选取2017年5月-2020年1月武汉市第五医院收治的68例AL并发感染患者作为研究组，另选取本院同期收治的AL未并发感染患者50例为AL组，同期于本院体检中心检查正常的30例健康志愿者作为健康对照组。测定和比较3组患者血清中肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）、白介素-10（IL-10）的水平和外周血Th1/Th2细胞亚群比值，并比较轻中度感染（n=52）和感染性休克（n=16）患者血清IL-6、IL-10、TNF-α、Th1/Th2水平，分析IL-6、IL-10、TNF-α、Th1/Th2与AL感染之间的关系.
结果: 研究组和AL组患者血清IL-6、IL-10、TNF-α水平和Th2比例均明显高于健康对照组（P＜0.001），Th1比例和Th1/Th2比值均明显低于健康对照组（P＜0.001）；且研究组患者IL-6、IL-10、TNF-α水平和Th2比例均明显高于AL组（P＜0.001），Th1比例和Th1/Th2比值均明显低于AL组（P＜0.001）。感染性休克组血清IL-6、IL-10、TNF-α水平均明显高于轻中度感染组（P＜0.001），Th1/Th2比值低于轻中度感染组（P＜0.001）。ROC曲线分析结果显示，IL-6、IL-10、TNF-α、Th1/Th2单独诊断感染性休克的ROC曲线下面积分别为0.779、0.761、0.724和0.718，均低于4项指标联合诊断感染性休克的ROC曲线下面积0.910（P＜0.05）.
结论: 血清IL-6、IL-10、TNF-α在AL并发感染及感染性休克患者血清中均处于较高水平，Th1/Th2细胞亚群比值则均较低；血清IL-6、IL-10、TNF-α和Th1/Th2联合检测对于预测AL重度感染感染性休克的发生具有较好的诊断价值.
Keywords: acute leukemia; helper T cell 1/helper T cell 2 cytokine; infection; interleukin-10; interleukin-6.