结核性胸膜炎患者外周血和胸水γδT和Th17细胞的频率变化及其意义

γδT and Th17 cells in peripheral blood and pleural effusion of tuberculous pleurisy

目的通过检测结核性胸膜炎患者抗结核治疗前后胸水和外周血中γδT细胞和Th17细胞的比例,探讨2群细胞在该病的发生及治疗过程中的变化及意义。方法选取结核性胸膜炎患者30例,分别采集患者抗结核治疗前和治疗后(7～10 d)的胸水及外周血,分离单个核细胞,采用流式细胞术检测γδT和Th17细胞的比例,同时设立健康对照组。结果与健康对照组相比,抗结核治疗前结核性胸膜炎患者外周血中CD3+T细胞比例显著降低(P<0.05),而γδT细胞的比例显著升高(P<0.05),表达IFN-γ的CD3+T和γδT细胞比例均显著升高(P<0.01);患者胸水中的CD3+T和γδT细胞比例显著高于患者外周血(P<0.05),胞内IFN-γ水平与2群细胞变化一致。抗结核治疗后患者外周血和胸水中CD3+T细胞比例较治疗前升高而γδT细胞比例下降,胞内IFN-γ的水平较治疗前显著降低(P<0.05)。抗结核治疗前结核性胸膜炎患者外周血中CD4+T细胞比例较健康对照组显著降低(P<0.01)而Th17细胞比例显著升高(P<0.01);患者胸水中CD4+T细胞显著高于外周血(P<0.05)而Th17细胞比例显著降低(P<0.05)。抗结核治疗后患者胸水中CD4+T和Th17细胞比例较治疗前升高但无显著性差异;IL-17+T与Th17细胞之间无显著相关性,而CD4+RORγt+T与Th17细胞之间存在显著相关性(r=0.564,P<0.05)。结论γδT和Th17细胞在抗结核治疗前后具有显著差异提示2群细胞可能在结核性胸膜炎的发病和治疗中发挥重要作用。

To detect the propotion and role of γδT cells and Th17 cells in patients’ blood and pleural effusion with tuberculous pleurisy,we collected 30 patients’ peripheral blood and pleural effusion before and after treatment.After isolating mononuclear cells,we detected the CD3 + T,γδT,CD4 + T and Th17 cells by use flow cytometroy.The proportion of CD3 + T and CD4 + T cells in patients’ blood decreased but increased significantly in patients’ pleural effusion,after treatment it increased higher in pleural effusion.The proportion of γδT cells in peripheral blood of tuberculous pleurisy before and after treatment is higher markedly than the heathy group,and that in patient’s pleural effusion is higher than in blood,but it reduced after cured.The proportion of Th17 cells is higher significantly in patients’ peripheral blood than control group but it is lower in the pleural effusion than in blood.And after treatment Th17 cell level both in patients’ peripheral blood and pleural effusion increased than before treatment.So the result suggest that γδT and Th17 cells may play an important role in the treatment of tuberculous pleurisy.