复治肺结核患者细胞免疫功能的分析

Analysis of cellular immune function in patients with retreatment pulmonary tuberculosis

目的研究复治肺结核患者细胞免疫功能的变化及其意义。方法2009年8月至2012年1月在常熟市第二人民医院传染病分院住院的结核病患者120例，其中男78例，女42例；年龄22—85岁，平均57岁；随机分为复治肺结核组60例和初治肺结核组60例。将60例复治肺结核患者分为1～2个肺野（26例）、3-4个肺野（14例）、5—6个肺野（20例）3个组及痰结核菌阳性组（34例）、阴性组（26例）2个组。采用流式细胞仪检测外周血中T淋巴细胞亚群（CD4^＋、CD8^＋、CD4^＋／CD8^＋），并进行分析。结果复治肺结核患者外周血中CD4^＋／CD8^＋（1．7±0．6）显著低于初治肺结核患者（2．0±0．8），差异有统计学意义（P〈0．05）。复治肺结核患者中病变为5～6个肺野组CD4^＋／CD8^＋（1．6±0．7）显著低于1～2个肺野组（2．1±0．6），差异有统计学意义（P〈0．05）。结论复治肺结核患者的细胞免疫功能显著低于初治肺结核患者，复治肺结核患者的细胞免疫功能与其病变范围密切相关，提示复治肺结核采用免疫调节剂辅助治疗的必要性。

Objective To study the change and significance of peripheral blood T-lymphocyte subsets in patients with retreatment pulmonary tuberculosis. Methods A total of 120 patients with tuberculosis in branch hospital of infectious diseases of the second people ＇ s hospital of Changshu from August 2009 to January 2012, including 78 males and 42 females, aged from 22 to 85 years （average 57 years）, were included in this study. The patients were divided into retreatment pulmonary tuberculosis group （60 cases） and initial treatment pulmonary tuberculosis group （60 cases）. Furthermore, the 60 patients with retreatment pulmonary tuberculosis were divided into different subgroups according to the lung fields involved and phlegm mycobacterium tuberculosis check results： Patients with involvement of 1 - 2 lung fields （26 cases）, vs 3 -4 lung fields （14 cases） and 5 -6 lung fields （20 cases）, patients with phlegm positive check results （34 cases） vs phlegm negative check results （26 cases）. Peripheral blood T-lymphocyte subsets （by flow cytometry doubled-labeled antibody） were determined and analyzed in 120 patients. Results The levels of peripheral blood CD4 ＋/CD8 ＋ in patients with retreatment pulmonary tuberculosis were significantly lower than those in initial treatment pulmonary tuberculosis patients （ 1.7 ± 0. 6 and 2.0 ± 0. 8, respectively, t = - 2. 813,P 〈 0. 05）. The levels of peripheral blood CD4 ＋/CD8 ＋ in patients with 5 -6 lung fields retreatment pulmonary tuberculosis were significantly lower than those in patients with 1 - 2 lung fields retreatment pulmonary tuberculosis （ 1.6 ± 0.7 and 2. 1 ± 0. 6, respectively, F = 4. 000,P 〈 0. 05 ）. Conclusions Patients with retreatment pulmonary tuberculosis have lower cellular immune function compared to those with initial treatment pulmonary tuberculosis, and the cellular immune function is significantly correlated with the extent of pulmonary lesions. All of the above indicate that it is necessary to consider immune regulators as supportive treatment for retreatment pulmonary tuberculosis.