肺结核患者支气管肺泡灌洗液微生物群与抗结核免疫反应类型的作用关系  

Analysis of the interaction between microflora of bronchoalveolar lavage fluid and type of anti-tuberculosis immune response in patients with pulmonary tuberculosis

作　　者：曹达兴 刘桂花 夏泽平 Cao Daxing;Liu Guihua;Xia Zeping(Department of Infection,the Second Hospital of Zhejiang Medical School of Changxing District(Changxing County People′s Hospital),Zhejiang Huzhou 313100,China)

机构地区：[1]浙江大学医学院附属第二医院长兴院区(浙江省长兴县人民医院)感染科,浙江湖州313100

出　　处：《中国医师进修杂志》2021年第9期815-820,共6页Chinese Journal of Postgraduates of Medicine

基　　金：浙江省基础公益研究计划(LGF19H010001)。

摘　　要：目的探究肺结核患者下呼吸道微生物群与抗结核分枝杆菌免疫反应类型及临床特征的关系。方法回顾性分析浙江大学医学院附属第二医院长兴院区2018年1月至2020年3月80例肺结核患者和80例非肺结核患者的临床资料。患者均行支气管肺泡灌洗,采用细菌培养法检测支气管肺泡灌洗液中嗜血杆菌、奈瑟菌、链球菌和韦荣球菌的数量,采用实时聚合酶链反应检测支气管肺泡灌洗液T-bet mRNA(Th1反应)和GATA-3 mRNA(Th2反应)相对表达水平。记录肺结核患者的临床症状。相关性采用Pearson相关分析。结果肺结核患者和非肺结核患者支气管肺泡灌洗液奈瑟菌、韦荣球菌和嗜血杆菌比较差异无统计学意义(P>0.05);肺结核患者支气管肺泡灌洗液链球菌明显少于非结核患者(630±120比1000±330),差异有统计学意义(P<0.05)。肺结核患者和非肺结核患者T-bet mRNA比较差异无统计学意义(P>0.05);肺结核患者GATA-3 mRNA表达水平明显低于非肺结核患者[(5.883±1.864)×10^(4)比(3.997±1.186)×10^(6)],差异有统计学意义(P<0.05)。Pearson相关分析结果显示,肺结核症状和体征中的发热与支气管肺泡灌洗液奈瑟菌和韦荣球菌呈正相关(r=0.402和0.566,P<0.01或<0.05);肺结核症状和体征中结核病灶占肺部面积比与T-bet和GATA-3 mRNA表达水平呈正相关(r=0.024和0.442,P<0.05),体质量减轻与T-bet mRNA表达水平呈正相关(r=0.112,P<0.05);GATA-3 mRNA表达水平与支气管肺泡灌洗液奈瑟菌呈正相关(r=0.332,P<0.05),T-bet mRNA表达水平与支气管肺泡灌洗液嗜血杆菌呈正相关(r=0.162,P<0.05)。结论肺结核患者的Th1/Th2免疫应答类型与支气管肺泡灌洗液中的嗜血杆菌、奈瑟菌存在相关性,并且患者的发热症状与奈瑟菌和韦荣球菌亦相关,体质量减轻和结核病灶占肺部面积比与免疫应答类型有一定的相关性。Objective To explore the relationship between lower respiratory tract microflora and type of anti-tuberculosis immune response,clinical characteristics in patients with pulmonary tuberculosis(PT).Methods The clinical data of 80 patients with PT and 80 patients with non-PT from January 2018 to March 2020 in the Second Hospital of Zhejiang Medical School of Changxing District were retrospectively analyzed.All patients were treated with bronchoalveolar lavage,the bronchoalveolar lavage fluid counts of Haemophilus,Neisser coccus,Streptococcus and Veillonella were detected by germiculture,and the bronchoalveolar lavage fluid expression levels of T-bet mRNA(Th1 immune response)and GATA-3 mRNA(Th2 immune response)was detected by real-time polymerase chain reaction.The clinical symptoms of PT were recorded.The correlation was analyzed by Pearson correlation analysis.Results There were no statistical differences in bronchoalveolar lavage fluid Neisser coccus,Veillonella and Haemophilus between patients with PT and patients with non-PT(P>0.05);the bronchoalveolar lavage fluid Streptococcus in patients with PT was significantly lower than that in patients with non-PT(630±120 vs.1000±330),and there was statistical difference(P<0.05).There was no statistical difference in expression level of T-bet mRNA between patients with PT and patients with non-PT(P>0.05);the expression level of GATA-3 mRNA in patients with PT was significantly lower that in patients with non-PT:(5.883±1.864)×10^(4) vs.(3.997±1.186)×10^(6),and there was statistical difference(P<0.05).Pearson correlation analysis result showed that fever was positively correlated with bronchoalveolar lavage fluid Neisser coccus and Veillonella(r=0.402 and 0.566,P<0.01 or<0.05);proportion of tuberculosis foci to lung area was positively correlated with T-bet and GATA-3 mRNA(r=0.024 and 0.442,P<0.05),the body weight loss was positively correlated with T-bet mRNA(r=0.112,P<0.05);GATA-3 mRNA was positively correlated with bronchoalveolar lavage fluid Neisser coccus(r=0.3

关 键 词：结核 肺 分枝杆菌 结核 免疫 支气管肺泡灌洗 

分 类 号：R521[医药卫生—内科学]