获得性免疫缺陷综合征合并肺结核患者肺CT征象与Th17/Treg失衡的关系  

Relationship between Pulmonary CT Signs and Th17/Treg Imbalance in Patients with Acquired Immune Deficiency Syndrome Complicated with Pulmonary Tuberculosis

作　　者：范子建 赵丽娜[2] 王立静[3] 张坤[4] FAN Zijian;ZHAO Lina;WANG Lijing;ZHANG Kun(department of operating room,the fifth hospital of shijiazhuang city,shijiazhuang 050200,china;department of internal medicine,the fifth hospital of shijiazhuang city,shijiazhuang 050200,china;department of infection,the fifth hospital of shijiazhuang city,shijiazhuang 050200,china;department of nursing,the fifth hospital of shijiazhuang city,shijiazhuang 050200,china)

机构地区：[1]石家庄市第五医院手术室,石家庄050200 [2]石家庄市第五医院内科,石家庄050200 [3]石家庄市第五医院感染科,石家庄050200 [4]石家庄市第五医院护理部,石家庄050200

出　　处：《临床误诊误治》2024年第17期32-37,共6页Clinical Misdiagnosis & Mistherapy

基　　金：河北省医学科学研究课题(20231695)。

摘　　要：目的探讨获得性免疫缺陷综合征(AIDS)合并肺结核患者肺CT征象与辅助性T细胞17(Th17)/调节性T细胞(Treg)失衡的关系。方法选取2015年6月至2019年6月就诊的AIDS合并肺结核患者58例作为观察组,另选同期单纯肺结核患者30例作为对照组。观察2组肺CT征象;采用流式细胞术检测外周血Th17、Treg比例并计算Th17/Treg比值变化;采用酶联免疫吸附试验测定血清白细胞介素-17、白细胞介素-10水平;并分析观察组外周血Th17/Treg比值与非典型肺结核肺CT征象的关系。结果与对照组比较,观察组弥漫性粟粒影、多发空洞、多肺段渗出、胸腔积液、肺门及纵隔淋巴结增大、2个以上肺段病变比例显著增高,肺部钙化影发生率明显降低(P<0.05,P<0.01)。与对照组比较,观察组外周血Th17比例、Th17/Treg比值、血清白细胞介素-17水平明显降低,Treg比例、血清白细胞介素-10水平升高(P<0.05)。Th17/Treg比值越低,非典型肺结核肺CT征象发生率越高(P<0.01)。结论AIDS合并肺结核患者肺CT征象不典型比例较高,Th17/Treg失衡,肺CT征象联合Th17/Treg比值对AIDS合并肺结核患者具有较好的临床诊断价值。Objective To investigate the relationship between pulmonary CT signs and the imbalance of helper T cell 17(Th17)/regulatory T cell(Treg)in patients with acquired immune deficiency syndrome(AIDS)complicated with pulmonary tuberculosis(PTB).Methods From June 2015 to June 2019,58 patients with AIDS combined with PTB were selected as the observation group,and 30 patients with simple PTB were selected as the control group.Pulmonary CT signs in the two groups were observed.The proportion of Th17 and Treg in peripheral blood was measured by flow cytometry and the Th17/Treg ratio was calculated.Serum levels of interleukin-17(IL-17)and interleukin-10(IL-10)were determined by enzyme-linked immunosorbent assay.The relationship between Th17/Treg ratio in peripheral blood and pulmonary CT signs of atypical PTB was analyzed.Results Compared with the control group,the observation group had diffuse miliary shadow,multiple cavities,multi-segmental exudation,pleural effusion,enlargement of hilar and mediastinal lymph nodes,significantly increased proportion of lesions in more than two lung segments,and significantly decreased incidence of pulmonary calcification shadow(P<0.05,P<0.01).Compared with the control group,Th17 proportion,Th17/Treg ratio and serum IL-17 level in peripheral blood of observation group were significantly decreased,while Treg proportion and serum IL-10 level were increased(P<0.05).The lower the Th17/Treg ratio,the higher the incidence of pulmonary CT signs of atypical PTB(P<0.01).Conclusion The proportion of atypical pulmonary CT signs and Th17/Treg imbalance are high in AIDS patients with PTB.The combination of pulmonary CT signs combined with Th17/Treg ratio has good clinical value in AIDS patients with pulmonary CT signs.

关 键 词：获得性免疫缺陷综合征 肺结核 CT检查 辅助性T细胞17 调节性T细胞 白细胞介素-17 白细胞介素-10 

分 类 号：R512.91[医药卫生—内科学]