肺结核感染肺野数和空洞形成与免疫状况的关系  

Correlation analysis between pulmonary tuberculosis infected fields,cavity formation and immune status

作　　者：卢春丽[1] 汪敏[2] 谢贝[3] 黄亚玲[1] 李艳[2] LU Chunli;WANG Min;XIE Bei;HUANG Yaling;LI Yan(Department of Clinical Nutrition,Guangzhou Chest Hospital,Guangzhou 510095,Guangdong,China;Department of Tuberculosis,Guangzhou Chest Hospital,Guangzhou 510095,Guangdong,China;Department of Clinical Laboratory,Guangzhou Chest Hospital,Guangzhou 510095,Guangdong,China)

机构地区：[1]广州市胸科医院临床营养科,广东广州510095 [2]广州市胸科医院结核内四科,广东广州510095 [3]广州市胸科医院医学检验科,广东广州510095

出　　处：《广州医科大学学报》2024年第6期26-31,共6页Academic Journal of Guangzhou Medical University

基　　金：广东省医学科学技术研究基金(B2023259);广州市科技局市校(院)企联合资助项目(2024A03J0585)。

摘　　要：目的:综合评价免疫状况与肺结核(PTB)严重程度的关系及影响。方法:本描述性横断面研究涉及952名诊断为活动性PTB的住院患者。严重的PTB包括3个及以上的肺野感染,或存在肺结核空洞。选取多种指标评估免疫状况,包括CD4^(+)、CD8^(+)、CD3^(+)、CD4^(+)/CD8^(+)以及淋巴细胞(LYM)、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR),采用多变量逻辑回归来评估免疫状况和PTB的严重程度的关系,并调整了年龄、性别、吸烟和糖尿病的影响。结果:与一般PTB组相比,多肺野感染组和空洞组多为老年男性糖尿病患者,多肺野感染组免疫指标CD4^(+)、CD8^(+)、CD3^(+)、CD4^(+)/CD8^(+)以及LYM、NLR、PLR明显偏低,P均<0.001;在调整了年龄、性别、吸烟和糖尿病后,多肺野感染组PLR是危险因素,P<0.05。空洞组免疫指标CD8^(+)、CD3^(+)、以及NLR、PLR明显偏低,除外NLR的P<0.001,其余三个指标P<0.05;在调整了年龄、性别、吸烟和糖尿病后,空洞组CD8^(+)是保护性因素,P<0.05。结论:免疫状况与PTB的严重程度显著相关,维持足够的PLR和CD8^(+)水平有助于降低严重PTB的风险,分别是多肺野感染和空洞的发生率,改善患者的预后。Objective:To evaluate the relationship between immune status and severity of pulmonary tuberculosis(PTB).Methods:This descriptive cross sectional analysis involved 952 hospitalized patients diagnosed with active PTB.Serious PTB includes three or more pulmonary fields infected,or with pulmonary tuberculosis cavities.Multivariable logistic regression was used to estimate the association between immune status and severity of PTB,including CD4^(+),CD8^(+),CD3^(+),CD4^(+)/CD8^(+),and Lymphocyte(LYM),Neutrophil to lymphocyte ratio(NLR),and Platelet to lymphocyte ratio(PLR),and the effects of age,gender,smoking,and diabetes mellitus were adjusted.Results:Compared with the normal PTB group,the MPI group and the cavity group were mostly aged men with diabetes mellitus.CD4^(+),CD8^(+),CD3^(+),CD4/CD8^(+),LYM,NLR,PLR in the MPI group were significantly lower(P<0.001).After adjusting for age,gender,smoking and diabetes mellitus,PLR was the risk factor in the multi-field infection group(P<0.05).CD8^(+),CD3^(+),NLR and PLR were significantly lower in cavernous group,except NLR(P<0.001),the other three indexes(P<0.05).After adjusting for age,gender,smoking and diabetes mellitus,CD8^(+)was protective in the cavity group(P<0.05).Conclusion:Immunity status was significantly associated with PTB severity.Maintaining adequate PLR and CD8^(+)levels helped reduce the risk of severe PTB,the incidence of multipulmonary wild infection and hollow spaces,respectively,and improved patient outcomes.

关 键 词：免疫状况 肺结核 空洞 血小板与淋巴细胞比值 

分 类 号：R521[医药卫生—内科学]