复治肺结核与初治结核病患者外周血T细胞亚群等的变化及其意义  

Changes and significance of peripheral blood T cell subsets, soluble interleukin-2 receptor and interferon-gamma in patients with retreatment pulmonary tuberculosis and initial treatment tuberculosis

作　　者：张少俊[1] 肖和平[1] 

机构地区：[1]同济大学附属上海市肺科医院结核病诊疗中心上海市结核（肺）重点实验室,200433

出　　处：《中华结核和呼吸杂志》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）

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）

关 键 词：结核 T淋巴细胞亚群 受体 白细胞介素2 干扰素Ⅱ型 

分 类 号：R521[医药卫生—内科学]