外周血辅助性T细胞亚群与肺结核严重性及疗效的关系

Influence of disease severity and antituberculosis treatment effectiveness on helper T-cells in peripheral blood from patients with pulmonary tuberculosis

目的:探讨外周血的Th1和Th2细胞与肺结核病变严重程度及疗效的关系。方法:应用细胞内细胞因子的检测方法对62例肺结核患者外周血的Th1和Th2细胞亚群进行检测,根据患者治疗前影像学肺部病灶累及程度及治疗前后影像学变化进行分组比较,30例健康者作为对照。结果:治疗前肺结核组的Th1细胞计数和Th2细胞计数均明显低于健康对照组(P<0.01,t检验)。治疗前多叶受累组的Th1细胞计数较局限组低(P<0.05,t检验);治疗后病灶吸收明显组的Th1细胞计数均恢复至健康水平(P>0.05,t检验);病灶吸收不明显组的Th1细胞计数仍低于健康水平(P<0.01,t检验);治疗后无论病灶吸收明显组或病灶吸收不明显组的Th2细胞计数均仍低于健康组(P<0.05,t检验)。结论:推测结核病的发生和进展可能与Th1细胞低下有关,非Th2型免疫反应增强所致,成功的抗结核治疗后,Th1细胞随之恢复。

Objective：To explore the influence of disease severity and effectiveness of antituberculosis treatment on helper T-cells in peripheral blood from patients with pulmonary tuberculosis.Methods：Th1 cells and Th2 cells of peripheral blood of 62 pulmonary TB patients and 30 controls were marked by intracellular cytokine（INF-γ and IL-4 representative of Th1 and Th2 subsets respectively） and counted by Flow Cytometry.The levels of Th1 and Th2 cell count from patients with different disease severities radiologically before antituberculosis therapy were compared and their correlation with effectiveness of different antituberculosis treatment radiologically was analyzed either.Results：The baseline levels of Th1 cell count and Th2 cell count in pulmonary tuberculosis group before antituberculosis therapy were significantly lower than those in the control group（P〈0.01,t test）.The baseline levels of Th1 cell count before antituberculosis therapy in diffuse group were significantly lower than those in limited group（P〈0.05,t test）.After two months of antituberculosis therapy,the levels Th1 cell count in the improved group increased to those of controls（P〈0.05,t test）.The levels of Th1 cell count in the stable group were still significantly lower than those in the control group（P〈0.01,t test）.The levels of Th2 cell count in both of the improved group and the stable group were still lower than those in the control group（P〈0.05,t test）.Conclusion：These results suggest that depressed Th1 responses are a prominent feature of human tuberculosis,and the depressed Th1 responses might recover after anti tuberculosis treatment,enhanced Th2 responses are absent in human tuberculosis.