复治肺结核患者外周血中活化（HLA—DR^＋）和静止（HLA—DR^-）T细胞的变化及其意义  

Changes and significance of activated （HLA-DR^＋） and unactivated （HLA-DR^-） T lymphocytes in peripheral blood of patients with retreated pulmonary tuberculosis

作　　者：唐神结[1] 肖和平[1] 胡家瑛[1] 李红[1] 顾瑾[1] 方勇[1] 杨晓君[1] 

机构地区：[1]同济大学附属上海市肺科医院、上海市结核肺重点实验室,200433

出　　处：《国际呼吸杂志》2009年第8期452-455,共4页International Journal of Respiration

摘　　要：目的 探讨结核病尤其是复治肺结核的免疫发病机制。方法 采用流式细胞术对106例复治肺结核患者外周血中活化和静止T细胞及T细胞亚群水平进行检测，并与142例初治和39例非活动性肺结核患者进行比较，同时对22例复治肺结核患者外周血中活化和静止T细胞水平进行随访。结果 外周血中CD3^＋、CD4^＋、CD8^＋、CD4^＋／CD8^＋、CD3^＋CD4^＋／CD3^＋、CD3^＋CD8^＋／CD3^＋T细胞水平3组病例间差异无统计学意义。外周血中活化总T细胞以复治组最低，组间差异有统计学意义（P〈0．05～0．01）。静止总T细胞以复治组最高，与其他两组相比差异有统计学意义（P〈0．05）。活化CD4^＋T细胞也以复治组最低，组间差异有显著统计学意义（P〈0．01）。静止CD4^＋T细胞以复治组为最高，其与非活动组相比差异有统计学意义（P〈0．05）。活化CD8^＋T细胞复治组最低，与非活动组和初治组相比差异有显著统计学意义（P〈0．01）。各组外周血中静止CD8^＋T细胞水平无明显差异。22例复治肺结核患者经过抗结核治疗后外周血中活化总T细胞和活化CD4^＋T细胞水平升高（P〈0．05）。结论 活化T细胞水平降低伴或不伴静止T细胞水平升高是复治肺结核重要的免疫学特征，也可能是复治肺结核发生与发展的重要原因。Objective To investigate the immunopathegenesis of tuberculosis, especially retreated pulmonary tuberculosis. Methods The concentrations of activated and unactivated T lymphocytes and T lymphocytes subsets were measured using flow cytometry in peripheral blood of 106 cases of retreated pulmonary tuberculosis, 142 cases of newly pulmonary tuberculosis and 39 cases of inactive tuberculosis. Meanwhile,the levels of activated and unactivated T lymphocytes in peripheral blood of 22 cases of retreated pulmonary tuberculosis were followed up. Results There were no significant differences in the numbers of CD3^＋ ,CD4^＋ ,CD8^＋ T lymphocytes and the ratios of CD4^＋/CD8^＋ ,CD3^＋CD4^＋/CD3^＋ ,CD3^＋ CD8^＋/CD3^＋ among three groups. The patients with retreated pulmonary tuberculosis presented a significant decrease（ P〈0.05-0.01） of activated CD3^＋ T lymphocytes,a significant predorminance （ P〈0.05） of unactivated CD3^＋ T lymphocytes,a significant reduction （ P〈0.01） of activated CD4^＋ T lymphoeytes,a significant increase （ P〈0.05） of unaetivated CD4^＋ T lymphoeytes,a significant decrease（ P〈0.01） of activated CD8^＋ T lymphocytes,compared to newly tuberculosis and inactive tuberculosis. There were no significant differences in the ratio of unactivated CD8^＋ T lymphocytes among three groups. After the antituberculous treatment, activated CD3^＋ and CD4^＋ T lymphocytes of 22 cases of retreated pulmonary tuberculosis increased （ P〈0.05） . Conclusions The reduction of activated T lymphocytes with or without the increase of unactivated T lymphocytes is an important immunological feature of retreated pulmonary tuberculosis and may lead to retreated pulmonary tuberculosis.

关 键 词：结核 肺 T细胞 流式细胞术 免疫发病机制 

分 类 号：R521[医药卫生—内科学] R512.62[医药卫生—临床医学]