背景:干扰素-γ(IFN-γ)释放测定(IGRA)是潜伏性结核分枝杆菌(TB)感染的重要实验室诊断。TB-IGRA测量IFN-γ从外周血细胞的释放,暴露于TB抗原(Ag)的人,丝裂原(MT),或体外阴性/无对照(NL)。同时,异常高的TBAg-NL水平将反映在相同条件下外周血淋巴细胞释放的IFN-γ的升高。因此,我们发现,TBAg-NL水平升高可能成为儿童系统性红斑狼疮(SLE)患者诊断和治疗的新生物标志物.
方法:分析2018-2020年广州市妇女儿童医学中心变态反应风湿病科776例患儿的临床资料。探讨TBAg-NL与SLE的关系,我们分析了47例SLE患者的临床资料和TBAg-NL检测结果,然后评估TBAg-NL与SLE疾病活动性之间的关联。
结果:活动性SLE患者的TBAg-NL水平明显高于非活动性SLE患者(p=0.0002)。TBAg-NL水平与SLE疾病活动指数(SLEDAI)和实验室诊断参数呈正相关。SLE患者的TBAg-NL平均值(0.04191±0.07955,IU/mL)明显高于青少年皮肌炎(JDM)患者(0.0158±0.0337,IU/mL,p=0.036),幼年特发性关节炎(JIA)(0.0162±0.0388,IU/mL,p=0.001),和健康对照(HC)(0.0001±0.0027,IU/mL,p=0.0003)。因此,升高的TBAg-NL水平可以作为SLE的潜在诊断生物标志物,特别是对于活跃的SLE。
结论:通过TB-IGRA检测IFN-γ释放水平可能有助于评估患有活动性SLE的小儿SLE患者的疾病活动性。
BACKGROUND: The interferon-gamma (IFN-γ) release assay (IGRA) is an important laboratory diagnosis for latent Mycobacterium tuberculosis (TB) infection. The TB-IGRA measures the release of IFN-γ from peripheral blood cells, who are exposed to TB antigen (Ag), mitogen (MT), or negative/nil control (NL) in vitro. While, an exceptional higher TB Ag-NL level will reflect an elevation of peripheral lymphocytes released IFN-γ in a same condition. Therefore, we found that the elevated levels of TB Ag-NL could become a new biomarker for the diagnosis and treatment of pediatric systemic lupus erythematosus (SLE) patients.
METHODS: We have analyzed the clinical data of 776 children who are underwent TB-IGRA testing in the Department of Allergy and Rheumatology of Guangzhou Women and Children\'s Medical Center from 2018 to 2020. To investigate the association between TB Ag-NL and SLE, we have analyzed the clinical data of 47 SLE patients and TB Ag-NL testing results, and then evaluated the association between TB Ag-NL and SLE disease activity.
RESULTS: The TB Ag-NL levels were significantly higher in patients with active SLE than those in inactive SLE (p = 0.0002). The TB Ag-NL levels were positively correlated with the SLE disease activity index (SLEDAI) and laboratory diagnosis parameters. The mean value of TB Ag-NL in SLE patients (0.04191 ± 0.07955, IU/mL) were significantly higher than those in patients with juvenile dermatomyositis (JDM) (0.0158 ± 0.0337, IU/mL, p = 0.036), juvenile idiopathic arthritis (JIA) (0.0162 ± 0.0388, IU/mL, p = 0.001), and healthy controls (HC) (0.0001 ± 0.0027, IU/mL, p = 0.0003). Therefore, the elevated TB Ag-NL levels could serve as a potential diagnostic biomarker of SLE, especially for the active SLE.
CONCLUSIONS: The detection of IFN-γ release levels by the TB-IGRA may be useful to assess SLE disease activity in pediatric patients with active SLE.