肺结核患者外周血树突状细胞和T辅助细胞水平的变化及其临床意义  

Study of Dendritic Cells and Th Cells in the Patients with Pulmonary Tuberculosis

作　　者：胥萍[1] 施美华[1] 费晓峰[1] 朱传武[1] 吴妹英[1] 吴敏娟[1] 张学光[2] 

机构地区：[1]苏州市第五人民医院中心实验室,江苏苏州215007 [2]苏州大学医学生物技术研究所,江苏苏州215007

出　　处：《苏州大学学报（医学版）》2010年第1期114-117,137,共5页Suzhou University Journal of Medical Science

基　　金：苏州市科学技术局资助项目[苏财科字(2005)47号]

摘　　要：目的探讨肺结核患者外周血树突状细胞(DC)与T辅助(Th)细胞水平的变化及其临床意义。方法利用流式细胞仪对73例初治肺结核患者、30名健康人外周血DCs亚群(DC1和DC2)与Th细胞亚群(Th1和Th2)按疾病分组进行检测。结果浸润性肺结核、结核性胸膜炎、粟粒型肺结核患者外周血中DC1、Th1含量均明显低于健康对照组,Th2含量均明显高于健康对照组(P<0.05或<0.01)。DC2含量在这3个病程中有下降趋势,前两者无显著差异(P>0.05),而粟粒型肺结核明显低于健康对照组(P<0.05)。粟粒型肺结核与浸润性肺结核患者外周血中Th1、Th2含量有明显差异(P<0.05)。糖尿病并发肺结核患者Th1含量明显低于肺结核组(P<0.05),Th2含量明显高于肺结核组(P<0.05)。15例重度肺结核患者经抗结核化疗与微卡治疗3个月后,DC1、DC2、Th1水平较治疗前明显升高(P<0.05),而Th2水平较治疗前明显降低(P<0.01)。结论浸润性肺结核、结核性胸膜炎、粟粒型肺结核患者存在着不同程度的免疫功能抑制,DC1、DC2表达水平调控着Th0向Th1、Th2分化,Th1、Th2的分化也间接地负反馈调节DC1、DC2表达,维持这种平衡对疾病的转归有重要意义。Objective To investigate the characteristics as well as relationship of subsets of dendritic cells（DCs）and the deviation of T-helper（Th）cells in the peripheral blood of patients with pulmonary tuberculosis.Methods Subsets of DCs and Th cells in the peripheral blood were detected by flow cytometry in 73 preliminary diagnosed patients with pulmonary tuberculosis and 30 healthy donors.Results Quantities of DC1 and Th1 cells in the peripheral blood of patients with pulmonary tuberculosis were significantly smaller,compared with those in the healthy controls（P0.01 or 0.05）,while the patients had more Th2 cells（P0.05）.The amount of DC2 decreased in the patients with infiltrative pulmonary tuberculosis,tuberculous pleurisy or miliary pulmonary tuberculosis.No significant difference in DC2 was observed between infiltrative pulmonary tuberculosis and tuberculous pleurisy（P0.05）,While the amount of DC2 in miliary pulmonary tuberculosis patients was significantly smaller than that in patients with infiltrative pulmonary tuberculosis（P0.05）.In the peripheral blood of patients with miliary pulmonary tuberculosis and infiltrative pulmonary tuberculosis,Th1 decreased significantly（P0.05）but Th2 increased significantly（P0.05）.In 15 patients with severe pulmonary tuberculosis,who had received antituberculosis chemotherapy and microcalorie therapy for 3 months,the amounts of DC1,DC2 and Th1 restored significantly（P0.05）and Th2 level dropped（P0.01）.Conclusion Immune function inhibition exists at different levels in patients with infiltrative pulmonary tuberculosis,tuberculous pleurisy and miliary pulmonary tuberculosis.The ratios of DC1 and DC2 controll the deviation of Th0 to Th1 or Th2.The deviation of Th1 and Th2 negative feedback regulates the amounts of DC1 and DC2.

关 键 词：肺结核 免疫分子 树突状细胞 T辅助细胞 

分 类 号：R521.03[医药卫生—内科学]