耐药空洞型肺结核患者手术前后调节性T淋巴细胞的改变

Change of regulatory T lymphocyte cells before and after pulmonary resection in the treatment of cavity tuberculosis

目的探讨耐药空洞型肺结核患者手术治疗前后外周血叉状头/翅膀状螺旋转录因子(forkhead/winged helixtranscription factor,Foxp3)表达阳性调节性T细胞(FoxP3^+regulatory T cells,Treg)水平改变。方法采用流式细胞术检测13例耐药空洞型肺结核患者手术治疗前后外周血淋巴细胞表面抗原CD4、CD25及胞浆内FoxP3的表达;同时以10例健康者外周血作为健康对照。结果耐药空洞型肺结核患者手术前外周血CD4^+、CD4^+CD25^-T细胞水平低于健康者(P<0.01);CD4^+CD25^+T细胞、CD4^+CD25^+FoxP3^+Treg细胞水平高于健康者(P<0.01)。与手术前比较,耐药空洞型肺结核患者手术治疗后1个月、6个月,CD4^+、CD4^+CD25^-T细胞水平升高,CD4^+CD25^+T细胞和CD4^+CD25^+FoxP3^+Treg细胞水平下降(P<0.01);手术治疗后6个月CD4^+CD25^+FoxP3^+Treg细胞水平较治疗后1个月下降(P<0.01)。结论耐药空洞型肺结核患者外周血CD4^+CD25^+FoxP3^+Treg细胞水平升高,有效手术治疗后下降。结核分枝杆菌可能通过诱导机体CD4^+CD25^+FoxP3^+Treg细胞增殖分化,从而产生免疫逃避。

Objective To investigate the forkhead/winged helix transcription factor（FoxP3^＋） circulating regulatory T cells（Treg） in patients with cavity tuberculosis before and after surgery. Methods We compared the proportion of Treg cells in 13 patients with cavity tuberculosis pre-and post-operatively and in 10 healthy control subjects by flow cytometry using three specific markers in peripheral blood lymphocytes： cell-surface CD4 and CD25 expression and intracellular FoxP3 expression.Results The proportion of CD4^＋and CD4^＋CD25^-T cells was significantly lower in patients with cavity tuberculosis than in controls（P〈0.01）; The proportion of CD4^＋CD25^＋T and CD4^＋CD25^＋FoxP3^＋Treg were significantly higher in patients with cavity tuberculosis than in healthy controls（P〈0.01）. Compared with before the operation, CD4^＋and CD4^＋CD25^-T cells levels increased in 1 month, 6 months after surgical treatment for pulmonary tuberculosis patients, CD4^＋CD25^＋T cells and the level of CD4^＋CD25^＋FoxP3^＋Treg cells decreased（P〈0.01）; The level of CD4^＋CD25^＋FoxP3^＋Treg cells decreased in 6 months than thatin 1 month after the operation（P〈0.01）. Conclusion Circulating Treg cells are increased in proportion in patients with cavity tuberculosis and decreased after surgery. Infection with M. tuberculosis may induce CD4^＋CD25^＋FoxP3^＋Treg cell-surface molecular changes with increased numbers of cells.