治疗期肺结核患者外周血CD4^+ T细胞变化的临床意义

The clinical significance of changes in CD4^+ T cell counts by peripheral blood from patients with pulmonary tuberculosis after antitubercular treatment

目的：探讨肺结核患者强化治疗期外周血CD4＋T细胞变化的临床意义。方法：应用流式细胞术对62例肺结核患者外周血的CD4＋T细胞计数，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，并与30例健康者作比较。结果：治疗前肺结核组CD4＋T细胞计数（439．21±210．56）／mm^3明显低于健康对照组（748．47±261．85）／mm^3（P〈0．01）。治疗前多叶受累组的CD4＋T细胞计数（399．83±194．17）／mm^3低于局限组对应的（521．90±224．40）／mm^3（P〈0．05）；治疗后病灶吸收明显组的CD4＋T细胞计数从（480．75±228．49）／mm^3上升至（616．75±280．57）／mm^3，达健康组水平（P〉0．05），而病灶吸收不明显的CD4＋T细胞计数仅从（412．97±197．00）／mm^3上升至（447．55±204．60）／mm^3，仍低于健康水平（P〈0．01）。结论：肺结核患者存在外周血CD4＋T细胞减少，经抗结核治疗后，外周血减少的CD4＋T细胞部分可恢复，外周血CD4＋T细胞与肺结核病情严重性相关，病情越严重CD4＋T细胞数越低。

AIM： To explore the clinical significance of changes in CD4^＋ T cell counts by peripheral blood from patients with pulmonary tuberculosis after antitubercular treatment. METHODS. CD4^＋ T cell counts in the peripheral blood of 62 pulmonary TB patients were counted by flow cytometry from groups auording to the radiologic extent of disease, and compared with those obtained from 30 controls. RESULTS： （1） The baseline levels of CD4^＋ T cell counts （439.21 ± 210.56）/mm3 in pulmonary tuberculosis group before antituberculosis therapy were significantly lower than those （748.47 ± 261.85）/mm3 in the control group （ P 〈 0.01 ）. （2） The baseline levels of CD4^＋ T cell counts （399.83 ± 194. 17）/mm3 before antituberculosis therapy in diffuse group were significantly lower than those （521.90 ± 224.40）/mm3 in limited group （P〈0.05）. （3） After two months of antituber- culosis therapy, the levels of CD4^＋ T cell counts in the improved group increased from （480. 75 ± 228.49）/mm3 to （616, 75 ± 280.57）/mm3, and the values were not significantly different from those in controls （ P 〉 0.05）. Whereas, the levels of CD4^＋ T cell counts in the stable group increased from （412.97 ±197.00）/mm^3 to （447.55 ± 204.60）/mm^3 , which were still significantly lower than those in the control group （ P 〈 0.01）. CONCLUSION： These results suggested that peripheral CD4^ ＋ lymphopenia was demonstrated in patients with pulmonary tuberculosis, and such lymphopenia was reversible partly with antitubercular treatment. The numbers of peripheral CD4^＋ T cell counts were related to the severity of the disease, the more severe of the disease was, the less numbers of the CD4^＋ T cell counts were.