| Objective:To explore the level of IL-27 in pleural effusion and peripheral blood of patients with tuberculous pleural effusion and elucidate its clinical implications.Methods:Pleural effusion patients from the Department of Respiratory and Tuberculosis and healthy volunteers from medical center were selected in Wuxi Fifth People's Hospital from November 2017 to May 2018.Finally 102 patients were included in the study:53 patients with tuberculous pleurisy(30 confirmed cases,including 12 cases of tuberculosis by thoracoscopic biopsy,8 cases of positive culture of pleural effusion tuberculosis,12 cases of pleural effusion tuberculosis nucleic acid test;23 cases of clinical diagnosis),49 patients with malignant pleural effusion.Pleural effusion and serum samples from patients with tuberculous pleural effusion and malignant pleural effusion were collected before treatment.And serum samples of 50 healthy volunteers from medical center were taken as healthy control.Serum samples of 53 patients with tuberculosis were collected after 4 weeks of antituberculosis treatment.All samples in each group were tested for IL-27 concentration by ELISA.The pleural effusions of tuberculosis and malignant groups were tested for IL-2,IL-10 and IFN-? concentrations by flow cytometry.Result:1.By ELISA,the IL-27 concentrations in the pleural fluid of the tuberculosis group and the malignant group were 516± 144 ng/l and 313±87 ng/l with statistically significant difference(t=8.47,P<0.001).The IL-27 concentrations in serum of tuberculosis,malignant and healthy controls were 285±44 ng/l,293±59 ng/l and 264±84 ng/l.There was no significant difference among the three groups(F=2.762,P>0.05).The IL-27 concentration of serum in the tuberculosis group was higher than that in the healthy group,and the difference was statistically significant(t=2.156,P<0.05).The ratio of IL-27 pleural fluid/serum in tuberculosis group and malignant group were 1.85±0.56 and 1.09±0.32 with statistically significant difference(t=8.32,P<0.05).The level of IL-27 in the pleural fluid of the tuberculosis group was higher than that in serum,and the difference was statistically significant(t=11.30,P<0.001).2.By flow cytometry,the levels of IL-10 and IFN-? in the pleural effusion of tuberculosis group were 398.08±19.45pg/ml and 704.17±169.53pg/ml.The concentrations of IL-10 and IFN-y in the pleural effusion of malignant group were 366.53 ± 73.76 pg/ml and 465.80±45.65 pg/ml,respectively.The concentrations of IL-10 and IFN-y in the pleural effusion of the tuberculosis group were higher than those in the malignant group,and the differences were statistically significant(t=3.038,P<0.05;t=9.81,P<0.001,respectively).The concentrations of IL-2 in pleural fluid of tuberculosis group and malignant group were 28.00±8.95pg/ml and 25.81±6.16pg/ml,and the difference was not statistically significant(t=1.58,P>0.05).3.From comparing the values of IL-27,IL-10 and IFN-y in the diagnosis of tuberculous pleurisy.Among the three cytokines,the sensitivity and negative predictive value of IL-27 in pleural fluid were the highest(88.0%and 86.4%)and the specificity and positive predictive value were also relatively high(78.0%and 78.6%).The specificity of IFN-y in pleural fluid was highest(90.6%),but the sensitivity,positive predictive value and negative predictive value were the lowest(81.0%,55.6%and 52.2%).The positive predictive value of IL-10 in pleural fluid was highest(96.2%),while the sensitivity,specificity and negative predictive value were relatively low(87.10%,58.50%and 58.50%).The sensitivity of combined diagnosis of IL-27,IL-10 and IFN-y in pleural fluid for tuberculous pleurisy was 95.9%,specificity was 90.6%,positive predictive value was 92.3%,negative predictive value was 94.0%,positive likelihood ratio was 10.20,the negative likelihood ratio is 0.05.4.Univariate logistic regression analysis found that the main factors associated with elevated pleural fluid IL-27 level in patients with tuberculous pleurisy include:diabetes,pleural effusion culture or smear positive,and statistically significant(the statistical results are?2=1.159,P=0.047,?2=4.003,P=0.032).Age,sex,unilateral and bilateral pleural effusion,pulmonary tuberculosis,fever,malnutrition,and encapsulated pleural effusion were not associated with elevated level of IL-27 in pleural effusion of patients with tuberculous pleurisy.(P>0.05).The level of IL-27 in the pleural effusion of patients in pleural effusion tuberculosis or smear positive group was significantly higher than that in the negative group(t=4.731,P<0.05).The level of IL-27 in pleural effusion of patients with tuberculous pleurisy and diabetes was higher than that without diabetes(1=2.202,P<0.05).5.Thirty patients diagnosed with tuberculous pleurisy were tested positive by tuberculosis nucleic acid detection of pleural effusion in 12 cases,and the sensitivity was 40.00%.The positive result of IL-27 in pleural effusion was 26 cases,and the sensitivity was 86.67%,the difference was statistically significant(?2=31.603,P<0.001).49 patients with malignant pleural effusion were negative by tuberculosis nucleic acid detection of pleural effusion.37 patients with malignant pleural effusion were negative by IL-27 test of pleural effusion,and specificity was 75.51%.The specificity of pleural fluid tuberculosis nucleic acid detection for the diagnosis of tuberculous pleurisy was higher than IL-27 test,the difference was statistically significant(?2=13.674,P<0.001).6.Compared with the serum of patients before treatment,the level of IL-27 in serum of patients with tuberculous pleurisy was reduced after 4 weeks anti-tuberculosis treatment,the results were 285±44 ng/1 and 270±48 ng/l,the difference was statistically significant(t=2.103,P<0.05).Conclusion:IL-27 may be involved in local immune allergic reactions in pleural effusions in patients with tuberculous pleurisy.The test of IL-27 in pleural fluid has high sensitivity and specificity in the diagnosis of tuberculous pleurisy.Detecting the level of IL-27 in pleural effusion by ELISA is a simple and efficient method to diagnose tuberculous pleurisy.The decrease in serum level of IL-27 after anti-tuberculosis treatment may reflect the therapeutic effect of tuberculous pleural patients. |
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