支气管扩张症合并非结核分枝杆菌肺病患者T淋巴细胞亚群及营养状态研究  

T lymphocyte subsets and nutritional status of bronchiectasis patients complicated with nontuberculous mycobacterial pulmonary disease

作　　者：汝触会 陆书生 陈爱凤[1] 鲍志坚 何飞 RU Chuhui;LU Shusheng;CHEN Aifeng;BAO Zhijian;HE Fei(Department of Respiratory Medicine,Affiliated Hangzhou Chest Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;不详)

机构地区：[1]浙江大学医学院附属杭州市胸科医院呼吸内科,杭州310003 [2]浙江大学医学院附属杭州市胸科医院结核科,杭州310003

出　　处：《浙江医学》2021年第18期1983-1987,共5页Zhejiang Medical Journal

摘　　要：目的探讨支气管扩张症(BCS)合并非结核分枝杆菌(NTM)肺病患者T淋巴细胞亚群及营养状态。方法选取2017年6月至2020年12月浙江大学医学院附属杭州市胸科医院收治的BCS合并NTM肺病患者79例作为BCS合并NTM组,同期本院收治的单纯BCS患者79例作为单纯BCS组,同期在本院健康体检中心体检的健康志愿者60例作为对照组。比较3组研究对象T淋巴细胞亚群(CD_(3)^(+)、CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+))、血清白蛋白(ALB)、前白蛋白(PA)、总蛋白(TP)水平。采集BCS合并NTM组患者的痰标本或支气管肺泡灌洗液进行NTM培养,观察NTM感染情况,采用螺旋CT机对研究对象行胸部CT扫描,判定BCS合并NTM组患者受累肺叶数,比较BCS合并NTM肺病中不同受累肺叶数患者T淋巴细胞亚群水平、感染状况和营养状态。结果BCS合并NTM组患者CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)及血清TP、PA及ALB水平均低于单纯BCS组和对照组(均P<0.05),且单纯BCS组以上指标均低于对照组(均P<0.05)。支气管扩张累及5~6肺叶者CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)及血清TP、PA、ALB水平均低于1~2肺叶者及3~4肺叶者(均P<0.05),且3~4肺叶者CD_(3)^(+)、CD_(4)^(+)及血清ALB均低于1~2肺叶者(均P<0.05)。支气管扩张累及5~6肺叶者的反复感染率、Ⅳ组菌种感染率均高于1~2肺叶者及3~4肺叶者,且3~4肺叶者的反复感染率高于1~2肺叶者,差异均有统计学意义(均P<0.05)。结论BCS患者伴有明显T淋巴细胞亚群及营养紊乱,合并NTM肺病及BCS累及多支肺叶时细胞免疫功能及营养状态将进一步下降。Objective To investigate the T lymphocyte subsets and nutritional status of bronchiectasis(BCS)patients complicated with nontuberculous mycobacterial pulmonary disease.Methods From June 2017 to December 2020,79 patients with BCS and nontuberculous mycobacterial pulmonary disease(BCS/NTM group),79 patients with simple BCS(BCS group),and 60 healthy subjects(control group)were enrolled.The general information was collected,and the T lymphocyte subgroups(CD_(3)^(+),CD_(4)^(+),CD_(8)^(+),CD_(4)^(+)/CD_(8)^(+)),serum albumin(ALB),prealbumin(PA),total protein(TP)levels were measured in all subjects.The levels of T lymphocyte subsets were compared among patients with different numbers of lung lobes of BCS involvement.The sputum or bronchoalveolar lavage fluid(BALF)samples of patients in the BCS/NTM group were collected for NTM culture.The chest spiral CT scan was performed to determine the number of BCS-affected lung lobes,and the infection status and nutritional status of patients with different numbers of BCS-affected lung lobes were compared.Results The percentage of CD_(3)^(+),CD_(4)^(+),CD_(4)^(+)/CD_(8)^(+)and serum levels of TP,PA and ALB in the BCS/NTM group were significantly lower than those of the BCS group and the control group(all P<0.05),while these indicators in the BCS group were significantly lower than those the control group(all P<0.05).The percentage of CD_(3)^(+),CD_(4)^(+),CD_(4)^(+)/CD_(8)^(+)and serum levels of TP,PA and ALB in patients with 5-6 lung lobes involved in BCS were significantly lower than those with 1-2 lung lobes and 3-4 lung lobes involved(all P<0.05),while the percentage of CD_(3)^(+),CD_(4)^(+),serum ALB of the patients with 3-4 lung lobes involved were significantly lower than those with the 1-2 lung lobe involved(all P<0.05).The recurrent infection rate and the infection rate of group IV bacteria in patients with 5-6 lung lobes involved were higher than those with 1-2 lung lobes and those with 3-4 lung lobes involved,while the recurrent infection rate and the infection rate of g

关 键 词：非结核分枝杆菌 支气管扩张症 T淋巴细胞 营养状态 

分 类 号：R562.22[医药卫生—呼吸系统] R563[医药卫生—内科学]