结核特异性T细胞活化亚群在抗结核治疗及预后评估中价值  

The value of tuberculosis specific T cell activation subsets in anti-tuberculosis therapy and prognostic evaluation

作　　者：赵慈余 何咪娜[1] 鲁笑容 黄伟萍[1] 陈捷[1] 严玲利 Zhao Ciyu

机构地区：[1]浙江省余姚市人民医院,315400

出　　处：《浙江临床医学》2025年第1期34-36,共3页Zhejiang Clinical Medical Journal

基　　金：宁波市科技计划项目(2023J269)。

摘　　要：目的探讨肺结核患者外周血结核特异性T细胞活化亚群在抗结核治疗前后的变化及预后评估价值。方法选择2023年1月至2023年10月肺结核患者70例为观察组,同期体检健康者40例为对照组。观察组患者接受6个月抗结核治疗方案,应用流式细胞术检测两组外周血经结核杆菌特异性抗原培养刺激前后CD4^(+)CD69^(+)、CD4^(+)HLA-DR^(+)、CD4^(+)HLA-G^(+)T细胞百分比。疗程结束后根据临床治疗效果分为治愈组(49例)和治疗失败组(21例)。采用Pearson相关性分析治疗前后活化T细胞亚群百分比下降率与红细胞沉降率(ESR)、超敏C反应蛋白(hs-CRP)下降率的相关性。采用受试者工作特征曲线(ROC)分析活化T细胞亚群百分比对肺结核治疗预后的价值。结果观察组结核特异性CD4^(+)CD69^(+)、CD4^(+)HLA-DR^(+)、CD4^(+)HLA-G^(+)T细胞百分比高于对照组(P<0.05);治愈组治疗前外周血CD4^(+)CD69^(+)、CD4^(+)HLADR^(+)T细胞百分比高于治疗失败组(P<0.05);治愈组治疗后外周血CD4^(+)CD69^(+)、CD4^(+)HLA-DR^(+)、CD4^(+)HLA-G^(+)T细胞百分比和hs-CRP、ESR水平较治疗前均降低(P<0.05);Pearson相关分析显示,CD4^(+)CD69^(+)、CD4^(+)HLA-DR^(+)T细胞百分比下降率与hs-CRP下降率呈正相关(P<0.05);CD4^(+)CD69^(+)、CD4^(+)HLA-G^(+)T细胞百分比下降率与ESR下降率呈正相关(P<0.05);ROC曲线显示,各指标联合预测预后的效能高于单一指标,AUC值为0.853,敏感度和特异度分别为0.816和0.762。结论肺结核患者外周血结核特异性CD4^(+)CD69^(+)、CD4^(+)HLADR^(+)、CD4^(+)HLA-G^(+)T细胞百分比均升高,在有效的抗结核治疗后均下降,并且联合检测对肺结核治疗预后评估有较好的价值。Objective To investigate the changes of tuberculosis specific T cell activation subsets in peripheral blood of patients with pulmonary tuberculosis before and after anti-tuberculosis treatment and prognosis evaluation of pulmonary tuberculosis treatment.Methods 70 cases of pulmonary tuberculosis patients in Yuyao People's Hospital from January 2023 to October 2023 were selected as the observation group,and 40 healthy subjects were selected as the control group.Patients in the observation group received a standard 6-month anti-tuberculosis treatment regimen.Flow cytometry was used to detect the percentage of CD4^(+)CD69^(+),CD4^(+)HLA-DR^(+),CD4^(+)HLA-G^(+)T cells in peripheral blood of the observation group and the control group before and after Mycobacterium tuberculosis specific antigen culture stimulation.At the end of the course of treatment,according to the end of the treatment course,the observation group were divided into 49 cases in the cure group and 21 cases in the treatment failure group.Pearson correlation analysis was used to analyze the relationship between the decrease rate of activated T cell subsets and the decrease rate of hs-CRP and ESR before and after treatment.The receiver operating characteristic curve(ROC)was used to explore the predictive value of the proportion of activated T cell subsets for the prognosis of pulmonary tuberculosis treatment.Results The proportions of tuberculosis-specific CD4^(+)CD69^(+),CD4^(+)HLA-DR^(+),CD4^(+)HLA-G^(+)T cells in the observation group were higher than those in the control group(P<0.05).The percentages of CD4^(+)CD69^(+),CD4^(+)HLA-DR^(+)T cells in the peripheral blood of the cured group before treatment were significantly higher than those in the treatment failure group(P<0.05).The proportion of CD4^(+)CD69^(+),CD4^(+)HLA-DR^(+),CD4^(+)HLA-G^(+)T cells and the levels of hs-CRP and ESR in the peripheral blood of the cured group after treatment were significantly lower than those before treatment(P<0.05).Pearson correlation analysis showed that the per

关 键 词：抗结核治疗 预后 T细胞 结核特异性抗原 

分 类 号：R521[医药卫生—内科学]