抗结核药物相关性肝损伤患者外周血辅助性T淋巴细胞17／调节性T淋巴细胞比率的变化及其意义  

The changes of the ratio of T helper 17 and regulatory T cells in the peripheral blood of patients with antituberculosis drug-induced liver injury and its significance

作　　者：冉燕[1] 李佳[2] 罗亚文[2] 易学东[3] 赵建军[1] 

机构地区：[1]遵义医学院附属医院呼吸二科,563000 [2]遵义医学院附属医院感染科,563000 [3]遵义医学院附属医院药剂科,563000

出　　处：《中华传染病杂志》2015年第8期456-459,共4页Chinese Journal of Infectious Diseases

基　　金：贵州省科技厅社会发展公关项目（20113048）

摘　　要：目的观察肺结核抗结核化学治疗后药物性肝损伤患者外周血Th17／Treg比率的变化，并探讨其与肝功能的关系。方法选取2013年2月至2015年3月遵义医学院附属医院诊断为继发性肺结核的肝功能正常的住院患者90例，抗结核化学治疗2周后，21例患者ALT和（或）AST≥2×正常值上限（ULN），作为伴有肝损伤的肺结核组；其余69例ALT和（或）AST〈2×ULN，作为不伴肝损伤的肺结核组。抗结核化学治疗前抽取外周血检测Th17／Treg比率和肝脏生物化学指标，2周后复查，比较两组抗结核化学治疗前后Th17／Treg比率的变化及其与ALT、AST的相关性。数据采用t检验，相关性检验采用Pearson相关性分析。结果抗结核化学治疗前，两组间Th17、Treg及Th17／Treg比率的差异均无统计学意义（均P〉0．05）。抗结核化学治疗2周后，伴肝损伤的肺结核组和不伴肝损伤的肺结核组Th17[（2．522±0．388）／mL比（2．075±0．369）／mL，t=3．633，P〈0．01；（2．326±0．348）／mL比（1．929±0．402）／mL，t=6．468，P〈0．01）]和Th17／Treg比率（0．618±0．104比0．489±0．107，t=3．553，P〈0．01；0．554±0．108比0．450±0．098，t=6．353，P〈0．01）均较治疗前升高，差异有统计学意义，而Treg治疗前后变化不明显（均P〉0．05）；伴肝损伤的肺结核组Th17（t=2．203，P〈0．05）及Th17／Treg比率（t=2．345，P〈0．05）均较不伴肝损伤的肺结核组显著升高，差异有统计学意义。Th17／Treg比率与AI．T呈正相关（r=0．849，P=0．044），与AST无明显相关性（P〉0．05）。结论Th17／Treg比率的变化与肺结核抗结核化学治疗后药物性肝损伤有关。Objective To observe the changes of the peripheral blood T helper （Th）17 cells/ regulatory T cells （Treg） ratio in patients with anti-tuberculosis drug-induced liver injury, and to explore the relationship between Th17/Treg ratio and liver function. Methods Ninety inpatients with the diagnosis of secondary pulmonary tuberculosis （TB） from Affiliated Hospital of Zunyi Medical College from Feb. 2013 to Mar. 2015 were included in this study. All these patients had normal base line liver function. After 2 weeks of anti-TB chemotherapy, 21 patients with alanine transaminase （ALT） and/or aspartate aminotransferase （AST） ≥2 × upper limit of normal （UI.N） were defined as TB with liver injure group, the other 69 patients with ALT and/or AST〈2 × UI.N were defined as TB with non liver injured group. Before treatment and two weeks after anti-TB therapy, the peripheral blood Thl 7/Treg ratios and liver functions of all patients in both groups were detected in order to compare the changes of Th17/Treg ratios pre and post anti-TB chemotherapy and to explore the relationship between ThlT/Treg ratio and ALT/AST levels. Student＇s t test was used for statistical analysis, and Pearson correlation analysis was used for correlation test. Results Before treatment, there was no statistical significance of Th17, Treg and ThlT/Treg ratio between groups （P〉0. 05）. The Thl7 levels in TB with liver injured group （[2. 522±0. 388]/mL vs [2. 075±0. 369]/mL, t=3. 633, P〈0. 01） and TB with non-liver injured group （[2. 326±0.348]/mL vs [1.929±0.402]/mL, t=6. 468, P〈0. 01）, and Thl7/Treg ratios in both groups （0.618±0.104 vs 0.489±0.107, t=3. 553, P〈0.01; 0. 554±0. 108 vs 0.450±0. 098, t= 6. 353, P〈0.01） were all increased after anti-TB chemotherapy, with statistically significant differences. However, there was no statistical significance of Treg levels pre and post anti-treatment in both groups （both P〉0.05）. The Th17 level and Th17/Treg ratio in TB with liver injured group w

关 键 词：结核 肺 药物性肝损伤 抗结核 TH17/TREG 

分 类 号：R521[医药卫生—内科学] R575[医药卫生—临床医学]