肺结核合并慢性乙型肝炎患者T淋巴细胞免疫应答研究

Immune response of T lymphocytes in patients with pulmonary tuberculosis combined with chronic hepatitis B

目的研究结核病合并慢性乙型肝炎(乙肝)患者血清中Th1型细胞的细胞因子水平变化以及Th1、Th2的表达水平及意义。方法对21例肺结核并乙肝表面抗原(HBsAg)阳性患者、30例单纯肺结核患者及30例健康对照者,应用酶联免疫吸附试验(ELISA)测定其血清中肿瘤坏死因子(TNF)-α、干扰素(IFN)-γ、白细胞介素(IL)-12水平;运用流式细胞术检测外周血中CD4+T淋巴细胞及细胞内Th1、Th2的表达水平。结果单纯肺结核及肺结核并HBsAg阳性组TNF-α水平均显著高于健康对照组(均P<0.01);单纯肺结核组IFN-γ、IL-12水平均显著低于健康对照组(均P<0.05),而肺结核并HBsAg阳性组IFN-γ、IL-12水平均显著低于单纯肺结核组(均P<0.01)。单纯肺结核组外周血CD4+T淋巴细胞及细胞内Th1表达水平均显著低于健康对照组(分别P<0.05,P<0.01);细胞内Th2表达水平显著高于健康对照组(P<0.05)。肺结核并HBsAg阳性组CD4+T淋巴细胞及细胞内Th1表达水平显著低于单纯肺结核组(分别P<0.05,P<0.01)。结论肺结核患者存在细胞内Th1反应减弱,Th2反应增强;而肺结核合并慢性乙肝的患者则进一步致细胞内Th1反应减弱,Th2反应增强。

Objective To study the serum levels of Thl lymphocyte factor and the expression pattern of Thl and Th2 in patients with pulmonary tuberculosis （PT）combined with chronic hepatitis B （CHB）. Methods Serum levels of tumor necrosis factor-α（TNF-α）, interferon-γ（IFN-γ）, interleukin-12 （IL-12） in 21 patients with PT combined with positive HBsAg, 30 simple PT patients and 30 healthy controls were detected with enzyme-linked immunosorbent assay （ELISA） ; and the expression pattern of CD4 ＋ T lymphocytes, Thl and Th2 cells in peripheral blood were detected by flow cytometry. Results The serum levels Of TNF-α in patients with simple PT and PT co-infected with CHB were both higher than that in healthy group （both P〈0. 01）;the serum levels of IFN-T and IL-12 in patients with simple PT were both lower than that in healthy group （both P〈0. 05） ; the serum levels of IFN-T and IL- 12 in patients with PT eo-infeeted with CHB were both lower than that in simple PT patients （both P〈0. 01）. The expression of CD4 ＋ T lymphocytes and Thl cells in simple PT patients were significantly lower than that in healthy group （P〈0. 05,P〈0. 01） ;The expression of Th2 cells in simple PT patients was significantly higher than that in healthy group （P〈0. 05） ;The expression of CD4 ＋ T lymphocytes and Thl cells in PT co-infected with CHB patients were significantly lower than that in simple PT patients （P〈0. 05,P〈0. 01）. Conclusion Patients with PT showed lower expression of Thl and higher expression of Th2; patients with PT co-infected with CHB showed further lower expression of Th1 and higher expression of Th2.