糖尿病合并肺结核患者外周血的免疫功能探讨  

Probe into the immunologic function of peripheral blood on patients with diabetes and tuberculosis

作　　者：杨勇琼 周晓明[2] 王建军[3] 

机构地区：[1]四川省三台县人民医院 [2]南京军区杭州疗养院海勤疗养区 [3]杭州师范大学附属医院

出　　处：《中国疗养医学》2011年第6期485-487,共3页Chinese Journal of Convalescent Medicine

摘　　要：目的探讨糖尿病(diabetes mellitus,DM)合并肺结核(tuberculosis,TB)病人外周血是否存在免疫缺陷。方法分离肺结核病人、糖尿病合并肺结核病人和健康人外周血单个核细胞,用1640完全培养基培养,加结核杆菌滤液刺激,48h后收集上清液,ELISA检测上清液中IL-12、IFN-γ、TNF-α和IL-10水平。诱导培养巨噬细胞,用巨噬细胞吞噬结核杆菌悬液,24h后裂解巨噬细胞培养未被杀灭的结核杆菌,10d后计数菌落数。结果①第9天巨噬细胞具有典型的结构特征。②DM+TB组巨噬细胞分泌TNF-α水平(597.5±69.1)pg/mL显著低于另两组[TB组(688.2±64.8)pg/mL,健康组(839.3±74.5)pg/mL],差异有统计学意义(F=18.48,P<0.05);TB组低于健康组,差异有统计学意义(P<0.05)。③DM+TB组巨噬细胞分泌NO水平(57.3±14.6)μmol/L显著低于另两组[TB组(83.5±23.3)μmol/L,健康组(108.9±22.3)μmol/L],差异有统计学意义(F=9.522,P<0.05);TB组低于健康组,差异有统计学意义(P<0.05)。④DM+TB组巨噬细胞内未被杀灭的结核杆菌数(lg CFU)(6.14±0.154)高于另两组[TB组(5.97±0.132)、健康组(5.77±0.127)],差异有统计学意义(F=11.165,P<0.05);TB组高于健康组,差异有统计学意义(P<0.05)。结论糖尿病合并肺结核病人体内巨噬细胞活化能力降低,分泌TNF-α、NO水平减少,巨噬细胞杀灭结核杆菌能力降低。糖尿病病人容易感染肺结核可能与其巨噬细胞免疫功能降低有关。Objective To investigate whether macrophages' immune function was deficient in patients of pulmonary tuberculosis complicated by diabetes mellitus.Methods The peripheral blood mononuclear cells were obtained respectively from patients with pulmonary tuberculosis complicated by diabetes mellitus,patients with tuberculosis and health individuals.And the cells were then cultured in 1 640 medium,collected the cells and the supernate fluid.Macrophages' ultramicrostructure was observed with perspective electron microscope.The level of TNF-α was measured by ELISA.24 hours later,breaking up macrophages,and then MTB was cultured in Lowenstein-Jensen medium,ten days later,counted it.Results ①The ninth day,microscope had typical construction features.②The level of TNF-α secreted by macrophages was much lower in DM+TB group(597.5±69.1)pg/mL than that the other groups[TB group(688.2±64.8)pg/mL,health group(839.3±74.5)pg/mL](F=18.48,P<0.05),and that in TB group was much lower than health group(P<0.05).③The level of NO secreted by macrophages was lower in DM+TB group(57.3±14.6)μmol/L than that in the other groups[TB group(83.5±23.3)μmol/L,health group(108.9±22.3)μmol/L](F=9.522,P<0.05),and that in TB group was lower than that in health group(P<0.05).④Viable count which was phagocytized by macrophage was much higher in DM+TB group(lg CFU)(6.14±0.154)than that in the other groups[TB group(5.97±0.132),health group(5.77±0.127)](F=11.165,P<0.05),and that in TB group was higher than that in health group(P<0.05).Conclusion The function of macrophages activation was degraded in patients of pulmonary tuberculosis complicated by diabetes mellitus.The levels of TNF-α and NO secreted by macrophages were degraded too.Macrophages' immune function was degraded in diabetes mellitus patients,that may be the reason why diabetes mellitus patients were infected with MTB easily.

关 键 词：糖尿病 结核病 巨噬细胞 结核杆菌 

分 类 号：R587.1[医药卫生—内分泌] R521[医药卫生—内科学]