T细胞、NKT和NK细胞在结核病诊断中的意义探讨

Clinical significance of T cells,NKT and NK cells in diagnosis and treatment of tuberculosis

目的探讨CD3+T细胞、CD3+CD16+CD56+N KT细胞及CD3-CD16+CD56+N K细胞在肺结核患者外周血的表达状态及其临床意义。方法采用流式细胞仪分析123例肺结核患者(73例初治肺结核和50例复治肺结核)及83例健康者(43例结核菌素皮试阳性和40例结核菌素皮试阴性)外周血中T细胞、NKT和NK细胞的表达率。结果初、复治肺结核患者的NKT细胞表达率明显高于健康者(P<0.01),但初治肺结核患者的NK细胞、T细胞的表达率与健康者相比差异无统计学意义(P>0.05)。T细胞表达率在不同程度的初治肺结核患者中差异有统计学意义(P<0.01),疾病越重,表达越高。NKT、NK细胞差异无统计学意义(P>0.05)。复治肺结核患者的T细胞表达率显著高于初治肺结核患者(P<0.01),但NK细胞、NKT细胞的表达率在2组间差异无统计学意义(P>0.05)。结论T细胞、NKT细胞是结核病细胞免疫的重要组成部分。对NKT细胞只在活动性肺结核患者才会呈现高表达,测定外周血NKT细胞可能成为辅助诊断活动性肺结核的手段之一。

Objective To explore the clinical expression and significance of CD3＋ T cells,CD3＋CD16＋CD56＋ N KT cells and CD3-CD16＋CD56＋ N K cells in pulmonary TB patients. Methods Percentages of T cells,N KT and NK cells in peripheral whole blood samples from 123 pulmonary TB patients（73 first-treated pulmonary TB and 50 retreated pulmonary TB） and 83 healthy controls（43 positive PPD test and 40 negative PPD test） were analyzed by flowcytometry. Results Percentage of NKT cells in first-treated and retreated pulmonary TB patients significantly increased than that in healthy controls（P0.01）,but percentages of T and NK cells had no significant difference between first-treated pulmonary TB patients and healthy controls（P0.05）.There was also a significant difference in the percentage of T cells according to severity of disease（P0.01）,while no significant difference in the percentages of NKT and NK cells could be found among these groups（P0.05）.Percentage of T cells in retreated pulmonary TB patients was significantly higher as compared with first-treated pulmonary TB patients（P0.01）,but those of NKT and NK cells had no significant difference（P0.05）. Conclusions T and NKT cells play an important role in cellular immunity against TB.To monitor the percentage of T cells in peripheral blood for pulmonary TB patients is helpful in finding recurrent tuberculosis and predicting prognosis.NKT cells in peripheral blood increase only in active TB patients.It can be used as one of the assistant non-invasive indicators for active pulmonary TB.