肺结核患者外周血T淋巴细胞亚群检测结果与病情的相关性研究

Study on correlation between examination results of T lymphocyte subsets in peripheral blood of patients with pulmonary tuberculosis and severity of their disease

目的 了解初治涂阳成年肺结核患者的外周血T淋巴细胞亚群检测结果与病情的相关性.方法 搜集2014年1月1日至2015年12月31日成都市公共卫生临床医疗中心收治的具有痰涂片抗酸杆菌检查阳性结果和外周血T淋巴细胞亚群检测结果的1561例新发成年肺结核患者资料,按照CD3＋、CD4＋和CD8＋T淋巴细胞检测水平分为如下各组：CD3＋降低组（876例,CD3＋水平低于770个/μl者）,CD3＋正常组（666例,CD3＋水平在770～2041个/μl者）,CD3＋升高组（19例,CD3＋水平高于2041个/μl者）;CD4＋降低1组（99例,CD4＋水平＜100个/μl者）,CD4＋降低2组（173例,CD4＋水平在100～199个/μl者）,CD4＋降低3组（267例,CD4＋水平在200～299个/μl者）,CD4＋降低4组（264例,CD4＋水平在300～413个/μl者）,CD4＋正常组（719例,CD4＋水平在414～1123个/μl者）,CD4＋升高组（39例,CD4＋水平高于1123个/μl者）;CD8＋降低组（743例,CD8＋水平低于238个/μl者）,CD8＋正常组（790例,CD8＋水平在238～874个/μl者）,CD8＋升高组（28例,CD8＋水平高于874个/μl者）.分析CD3＋、CD4＋和CD8＋T淋巴细胞计数水平与临床病情的相关性.上述各组资料分别采用Spearman相关系数（rs）、线性趋势检验,以及x2检验进行比较分析,均以P＜0.05为差异有统计学意义.结果 在1561例研究患者中,初治涂阳成年肺结核患者T淋巴细胞亚群均有不同程度改变,其中CD3＋、CD4＋和CD8＋T淋巴细胞计数出现下降者分别占56.12％（876/1561）、51.44％（803/1561）和47.60％（743/1561）.不同CD3＋、CD4＋和CD8 ＋组别的T淋巴细胞计数水平[（464.35±189.53）～（2417.80±421.24）个/μl、（65.71±22.51）～（1334.80±192.01）个/μl、（140.70±59.37）～（1049.10±220.56）个/μ1]与患者不同痰涂片结果[65.64％（575/876）～84.21％（16/19）、65.66％（65/99）～74.36％（29/39）、67.16％（499/743）～85.71％（24/28）]密切相关[Spearman相关系数（rs）=0.10,P＜0.001;rs=-0.06,P=0.014;rs=-0.05,P=0.035],且存在线性趋势（x2趋势=15.13,P＜0.001;x2趋势=6.80,P=0.009;x2趋势=5.54,P=0.019）.与不同受累肺叶与肺段[92.01％（806/876）～89.47％（17/19）、94.95％（94/99）～82.05％（32/39）、91.79％（682/743）～78.57％（22/28）]密切相关[rs=-0.19,rs=-0.16,rs=-0.16,P值均＜0.001],且存在线性趋势（x2趋势=42.39,x2趋势=34.64,x2趋势=32.07,P值均＜0.001）.结论 初治涂阳成年肺结核患者外周血CD3＋、CD4＋、CD8＋T淋巴细胞计数水平与病情密切相关,CD3＋、CD4＋、CD8＋T淋巴细胞计数水平降低越明显,肺结核患者痰菌数量越高、病变累及范围越多.

Objective To explore the correlation between the examination results of peripheral blood T lymphocyte subsets and the severity of the disease in adult patients with smear positive pulmonary tuberculosis （PTB）.Methods The information and data of 1561 adult patients who were diagnosed as smear positive PTB and had the examination results of peripheral blood T lymphocyte subsets,and treated in Chengdu Public Health Clinical Centre from January 1st,2014 to December 31st,2015 were collected.Those enrolled patients were grouped according to the levels of CD3＋,CD4＋ and CD8＋ cell counts：group with low CD3＋ （876 cases,the CD3＋ level was lower than 770/xl）,group with normal CD3＋ （666 cases,the CD3＋ level ranged 770-2041/μl）,group with high CD3＋ （19 cases,the CD3＋ level was higher than 2041/μl）;group 1 with low CD4＋ （99 cases,the level of CD4＋ was lower than 100/μl）,group 2 with low CD4＋ （173 cases,the level of CD4＋ was 100-199/μl）,group 3 with low CD4＋ （267 cases,the level of CD4 ＋ was 200-299/xl）,group 4 with low CD4＋ （264 cases,the level of CD4＋ was 300-413/μl）,group 5 with normal CD4＋ （719 cases,the level of CD4＋ was 414-1123/μl）,group 6 with high CD4＋ （39 cases,the level of CD4＋ was higher than 1123/μl）;group with low CD8 （743 cases,the level of CD8＋ was lower than 238/μl）,group with normal CD8＋ （790 cases,the level of CD8＋ was 238-874/μl）,group with high CD8＋ （28 cases,the level of CD8＋ was higher than 874/μl）.The correlation between the levels of CD3＋,CD4＋ and CD8 cell counts and the clinical conditions of these patients was analyzed.The data obtained from above mentioned groups were analyzed by using Spearman correlation coefficient （rs）,linear trend test and x2 test,and P〈0.05 was considered to be statistically significant.Results In 1561 adult smear-positive PTB patients,the T lymphocyte subsets in all patients had changed in varying degrees.Among them,the proportions of the patients with reduced CD3＋,CD4＋ and CD8＋ cell counts were 56.12% （876/1561）,51.44% （803/1561） and 47.60% （743/1561） respectively.The different levels of CD3＋,CD4＋ and CD8＋ cell counts （（464.35 ± 189.53）-（2417.80±421.24）/μl,（65.71±22.51）-（1334.80±192.01）/xl,（140.70±59.37） （1049.10±220.56）/μl）and the patients＇ sputum smear results （65.64% （575/876）-84.21% （16/19）,65.66% （65/99）-74.36% （29/39）,67.16% （499/743） 85.71% （24/28）） were closely related （Spearman correlation coefficient （rs）=0.10,P〈0.001;rs =-0.06,P=0.014;rs =0.05,P=0.035） and there was a linear trend （x2 =15.13,P〈0.001;x2 =6.80,P=0.009;x2 =5.54,P=0.019）;the different levels of CD3＋,CD4＋ and CD8＋ cell counts and the lesions of lung involved （92.01% （806/876）-89.47% （17/19）,94.95% （94/99）-82.05% （32/39）,91.79% （682/743）-78.57% （22/28）） were closely related also （rs =-0.19,rs =-0.16,rs=-0.16,P〈0.001）,and there was a linear trend （x2=42.39,x2=34.64,x2=32.07,P〈0.001）.Conclsion The levels of CD3＋,CD4＋ and CD8＋ cell counts in peripheral blood of the adult patients with smear positive PTB were closely related to the disease severity of those patients;the lower of CD3＋,CD4＋ and CD8 cell counts,the higher number of sputum bacteria in these patients and the more lesions involved.