摘要
目的比较复治肺结核与初治肺内外结核患者外周血T细胞亚群、可溶性白细胞介素-2受体（sIL-2R）和γ-干扰素的表达，探讨初治肺结核与复治肺结核、肺结核与肺外结核患者的细胞免疫功能变化及其意义。方法2009年12月至2011年1月在上海市肺科医院住院的结核病患者170例，其中男98例，女72例；年龄16～70岁，平均40岁。将170例分为复治肺结核组（47例）、初治肺结核组（62例）和初治肺外结核组（61例），将其中109例肺结核患者分为无空洞组（52例）和有空洞组（57例）及1～2个肺野组（48例）、3～4个肺野组（26例）和5—6个肺野组（35例）。采用流式细胞仪抗体双标法测定外周血中CD4和CD8T细胞，用双抗体夹心酶联免疫吸附试验法测定血清中可溶性白细胞介素-2受体（sIL-2R）和γ-干扰素的含量。两组问比较采用t检验，多组间比较采用方差分析，多个样本间的两两比较采用LSD-t检验或）（。检验，采用直线回归方程进行相关性分析。结果复治肺结核组和初治肺外结核组患者外周血中CD。／CD。（1．7±0．7和1．6±0．7）显著低于初治肺结核组（2．0±0．7）；血清中sIL-2R[（224±89）pmol／L和（209±98）pmol／L]显著高于初治肺结核组[（167±73）pmol／L]，γ-干扰素[（374-23）ng／L和（37±24）ng／L]显著高于初治肺结核组[（29±16）ng／L]，差异均有统计学意义（F值为2．799～6．402，P〈0．05和P〈0．01）。有空洞组外周血中CD4／CD8（1．7±0．6）明显低于无空洞组（2．04-0．8），血清中slL-2R和γ-干扰素[（214±93）pmol／L和（38±22）ng／L]显著高于无空洞组[（167±68）pmol／L和（27±14）ng／L]，差异均有统计学意义（t值为-2．813～3．076，P〈0．05和P〈0．01）。3组患者血清中sIL-2R水平与外周血中CD。／CD。呈显著负相关（r=-0．380，P〈0．01）。结论复治肺结核和肺外结核患者的细胞免疫功能显著低于初治肺结核患者，肺结核患者的细胞免疫功能与其病变范围和有无空洞密切相关。
Objective The aim of this study was to compare the expression of peripheral blood T cell subsets, soluble interleukin-2 receptor （sIL-2R） and interferon-gamma （IFN-γ） in patients with retreatment pulmonary tuberculosis, initial treatment pulmonary and extra-pulmonary tuberculosis, and therefore to explore the cellular immune changes and the significance among different types and severity of tuberculosis. Methods A total of 170 patients with tuberculosis in Pulmonary Hospital of Shanghai from December 2009 to January 2011, including 98 males and 72 females, aged from 16 to 70 years （ average 40 years）, were included in this study. The patients were divided into retreatment pulmonary tuberculosis group （47 cases）, initial treatment pulmonary tuberculosis group （62 cases） and initial treatment extra-pulmonary tuberculosis group （61 eases）. Furthermore, the 109 patients with pulmonary tuberculosis were divided into different subgroups according to cavity formation and the lung fields involved： patients without lung cavity （ 52 cases） vs those with lung cavity （ 57 cases）, patients with involvement of 1 - 2 lung fields （48 cases）, vs 3 -4 lung fields （26 cases） and 5 -6 lung fields （35 cases）. Peripheral blood T cell subsets （by flow cytometry doubled-labeled antibody）, sIL-2R and IFN-~, （by ELISA） were determined in 170 patients. Differences between means of 2 groups were tested by t test, differences among multiple groups were tested by analysis of variance （ANOVA）, and multiple comparisons among multiple groups were tested by LSD-t test or X2 test. Linear regression equation was used to analyze the correlations. Results The levels of peripheral blood CD4/CDs in patients with retreatment pulmonary tuberculosis and initial treatment extrapulmonary tuberculosis patients were significantly lower than that in initial treatment pulmonary tuberculosis patients, [ （ 1.7 ＋0. 7）, （ 1.6 ＋0. 7） and （2. 0 ＋0. 7） respectively （F =4. 380, P 〈0. 05） ]. The levels of serum sIL-2R in patients with retreatment pulmonary tuberculosis and initial treatment extra-pulmonary tuberculosis were significantly higher than that in initial treatment pulmonary tuberculosis patients [ （224＋ 89） pmol/L, （209 ＋ 98） pmol/L, （ 167 ＋ 73 ） pmol/L, （ F = 6. 402, P 〈 0. 01 ） ]. The levels of serum IFN-γ in patients with retreatment pulmonary tuberculosis and initial treatment extra-pulmonary tuberculosis were significantly higher than that in initial treatment pulmonary tuberculosis patients [ （ 37 ＋ 23 ） ng/L, （37 ＋24） ng/L, （29 ＋ 16） ng/L, （ F = 2. 799, P 〈 0.05 ） ]. The levels of peripheral blood CD4/CDs in initial treatment and retreatment eavity pulmonary tuberculosis patients were lower than that in pulmonary tubereulosis patients without cavity, but the results of sIL-2R and IFN-γ, were the opposite [ （ 1.7 ＋0. 6） vs （2.0＋0.8）, （214 ＋93） pmol/Lvs （167＋68） pmol/L and （38＋22） ng/Lvs （27＋14） ng/L, t= -2. 813 to 3. 076, P 〈 0. 05 or P 〈 0. 01 1. The level of serum sIL-2R was negatively correlated with peripheral blood CD4/CDs level in all the patients （ r = - 0. 380, P 〈 0. 01 ）. Conclusions Patients with retreatment pulmonary tuberculosis and initial treatment extra-pulmonary tuberculosis had lower cellular immune funetion as compared to those with initial treatment pulmonary tuberculosis, and the cellular immune function was significantly correlated with the extent and cavity formation of pulmonary lesions.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2011年第12期884-887,共4页
Chinese Journal of Tuberculosis and Respiratory Diseases
基金
国家“十一五”科技重大专项课题（2008ZX10003-015）
