结核性胸膜炎患者结核特异性T淋巴细胞的免疫应答及其迁徙作用  

Immune responses and immigration of Mycobacterium tuberculosis-specific T lymphocytes in patients with tuberculous pleuritis

作　　者：郑建[1] 欧勤芳[1] 刘袁媛[2] 周敏[1] 陈华昕[1] 钱超[1] 高岩[2] 翁心华[2] 张文宏[2] 邵凌云[2] 

机构地区：[1]无锡市第五人民医院肺科,214005 [2]复旦大学附属华山医院感染科

出　　处：《中华传染病杂志》2013年第12期715-718,共4页Chinese Journal of Infectious Diseases

基　　金：2012年无锡市科技局社会发展指导性项目（CSZ00N1229）

摘　　要：目的比较结核性胸膜炎患者外周血和胸腔积液中结核特异性T淋巴细胞的免疫反应。方法收集2012年10月至2013年4月在无锡市第五人民医院住院的结核性胸膜炎初治患者12例。同时采集其外周血和胸腔积液，细胞内细胞因子染色和流式细胞术检测外周血和胸腔积液中CD4＋IFN-γ＋T淋巴细胞和CD8＋IFN-γ＋T淋巴细胞的比例。数据分析采用非参数Mann—Whitney检验和配对秩和检验。结果入选患者外周血分泌IFNy的CD4＋。T淋巴细胞占CD4＋T淋巴细胞总数的中位数为0．91％，而胸腔积液中则达3．63％，显著高于外周血，差异有统计学意义（U=17．00，p=0．0017）。进一步的配对秩和检验分析亦显示，胸腔积液中分泌IFN-γ的CD4＋T淋巴细胞比例与外周血相比有显著的升高趋势（P=0．0015）；而CD8＋。T淋巴细胞则无此变化趋势（P=0．9219）。结论在结核性胸膜炎的发病过程中，结核特异性CD4＋。T淋巴细胞从外周血迁徙至胸腔，在病变局部发挥抗结核免疫作用。Objective To compare the immune responses of Mycobacterium tuberculosis （M. tb）-specific T lymphocytes between the peripheral blood and pleural effusion in patients with tuberculous pleurisy. Methods Twelve initially treated cases of tuberculous pleurisy who were hospitalized in Wuxi No. 5 People＇s Hospital from Oct 2012 to Apr 2013 were enrolled in this study. Both the peripheral blood and pleura[ effusion were collected from the enrolled patients. The percentages of CD4＊ IFN-7＋ T lymphocytes and CD8＋ IFN-7＋ T lymphocytes in the peripheral blood and pleural effusion were determined by intracellular cytokine staining and flow cytometry. The data were compared by non-parametric Mann-Whitney test and Wilcoxon matched pairs test. Results The percentage of CD4＋ IFN 7＋ T lymphocytes in the total CD4＋ T lymphocytes in the peripheral blood of the patients was 0. 91＋, while that was 3. 63~ in pleural effusion, which was significantly higher than that in the peripheral blood （U 17. 00, -P= 0. 0017）. Further Wilcoxon matched pairs test showed that the proportion of CD4＋ T lymphocytes secreting IFN-y in pleural effusion was also significantly higher than that in the peripheral blood （P=0. 0015）. However, there was no significant difference of CD8＋ T lymphocytes secreting IFN-y between blood and pleural effusion （P= 0. 9219）.Conclusions M. tb-specific CD4＋ T lymphocytes immigrate from the peripheral blood to the pleural cavity during the development of tuberculous pleurisy, and exert an anti-tuberculosis immunological effect in local lesion.

关 键 词：结核 胸膜 胸腔积液 干扰素Ⅱ型 CD4阳性T淋巴细胞 CD8阳性T淋巴细胞 

分 类 号：R521.7[医药卫生—内科学]