非耐药与耐多药肺结核患者外周血T淋巴细胞亚群及细胞因子的变化

Change in peripheral blood T lymphocyte subsets and cytokines in patients with drug-sensitive and multidrug-resistant pulmonary tuberculosis

目的对非耐药(DS)及耐多药(MDR)肺结核患者外周血T淋巴细胞亚群及细胞因子的变化及意义进行探讨。方法对某医院及某结核病防治所2011年7月—2012年7月住院的肺结核患者(其中DS肺结核患者20例,MDR肺结核患者15例)以及医院同期26例健康体检者(对照组)外周血的CD3+、CD4+、CD8+T淋巴细胞亚群进行检测;同时检测外周血干扰素(IFN)-γ、白细胞介素(IL)-10,对3组数据进行比较。结果 DS肺结核组、MDR肺结核组及对照组CD3+、CD4+、CD8+T淋巴细胞亚群的表达率比较,差异无统计学意义(P>0.05);3组患者CD3+、CD4+、CD8+T淋巴细胞绝对值比较,差异有统计学意义(P<0.01);各组间两两比较,差异亦有统计学意义(P<0.05),其中对照组CD3+[(1 426±485)/μL]、CD4+[(825±306)/μL]、CD8+T淋巴细胞[(516±213)/μL]绝对值最高,MDR肺结核组最低[分别为(746±358)/μL、(461±204)/μL、(213±101)/μL]。3组间IFN-γ浓度比较,差异有统计学意义(P<0.01);各组间两两比较,差异亦有统计学意义(P<0.05),其中对照组浓度[(65.04±36.31)pg/mL]最高,MDR肺结核组[(23.32±14.04)pg/mL]最低。3组间IL-10浓度比较,差异无统计学意义(P>0.05)。结论人类痰菌阳性肺结核及MDR肺结核患者外周血CD3+、CD4+、CD8+T淋巴细胞绝对值及血清IFN-γ有不同程度下降,其下降可能促进了结核病情进展,且可能为耐药肺结核形成的原因之一。

Objective To evaluate the changes and significance of T lymphocyte subsets and cytokines in peripheral blood of patients with drug-sensitive and multidrug-resistant pulmonary tuberculosis（MDR pulmonary TB）.Methods From July 2011 to July 2012,T lymphocyte subsets（CD3＋,CD4＋,and CD8＋T）and cytokines（IFN-γand IL-10）were detected in patients with drug-sensitive pulmonary TB（DS group,20 cases）,MDR pulmonary TB（MDR group,15 cases）and healthy physical examination persons（control group,26 cases）in a hospital,data of three groups were compared.Results No significant differences were found in percentages of CD3＋,CD4＋,and CD8＋T among three groups（P0.05）;there were significant differences in absolute counts of CD3＋,CD4＋,and CD8＋T among three groups（P0.01）,and the difference between every two groups was also significant（P0.05）,which was highest in control group（CD3＋[1 426±485]/μL;CD4＋[825±306]/μL;CD8＋T[516±213]/μL）and lowest in MDR group（CD3＋[746±358]/μL;CD4＋[461±204]/μL;CD8＋T[213±101]/μL）.There were significant differences in IFN-γvalue among three groups（P0.01）,and the difference between every two groups was also significant（P0.05）,which was highest in control group（[65.04±36.31]pg/mL）and lowest in MDR group（[23.32±14.04]pg/mL）.No significant differences were found in IL-10 among three groups（P0.05）.Conclusion The absolute counts of T lymphocyte subsets CD3＋,CD4＋,and CD8＋T as well as IFN-γdeclined in drug-sensitive pulmonary TB patients and MDR pulmonary TB patients,which may accelerate the progress of TB and be one of the causes of MDR pulmonary TB.