Th1/Th2细胞及细胞因子和结核性胸膜炎粘连的相关性

Study on relationship between Th1/Th2 cells/cell cytokines and tuberculosis pleural effusion adhesion

目的探讨结核性胸膜炎患者不同胸膜粘连程度和Th1、Th2细胞免疫的相关性。方法选取2014年8月至2016年12月住院的66例行内科胸腔镜手术确诊为结核性胸膜炎患者,测定胸水和血清中INF-γ、TNF-α、IL-2、IL-4的含量,应用流式细胞术检测胸水Th1、Th2细胞比例。结果患者分为无胸膜粘连组9例,轻度胸膜粘连组32例,重度胸膜粘连组25例。每组胸液中4种细胞因子均较血清中含量升高,差异有显著性。3组患者胸液中INF-γ、TNF-α的平均浓度随胸膜粘连程度加重而逐渐升高,重度胸膜粘连组INF-γ、TNF-α水平明显高于另外两组,差异均有显著性(P<0.05)。重度胸膜粘连组的Th1细胞比例明显高于无胸膜粘连组和轻度胸膜粘连组,差异有显著性(P<0.05)。结论结核性胸膜炎胸液中Th1细胞比例及INF-γ、TNF-α含量越高,胸膜的粘连程度越明显,证实过度强烈的Th1型细胞免疫反应能够对胸膜组织造成病理性免疫损伤,与胸膜粘连严重程度相关。

Objective To investigate the relationship between cellular immune response which is related with Thl/Th2 cells and the different severities of tuberculosis pleural effusion adhesion. Methods A total of 66 in- patients diagnosed with different severities of tuberculosis pleural effusion adhesion by internal thoracoseope were enrolled from August 2014 to December 2016. ELISA was used to determine levels of INF-γ, TNF-α, IL-2 and IL- 4. The ratio of Thl and Th2 cells was detected by flow cytometry. Results All the patients were divided into 3 groups ： 9 cases without pleural adhesion, 32 cases with mild pleural adhesion, 25 cases with severe pleural adhe- sion. The levels of 4 cytokines in pleural fluid were significantly higher than those in serum in each group （P 〈 0.05, respectively）. The concentrations of INF-γ and TNF-a were increased with the severity of tuberculosis pleu- ral effusion adhesion. The levels of INF-γ and TNF-a in the severe pleural adhesion group were markedly higher than those in the other two groups （P 〈 0.05, respectively）. The proportion of Thl cells in the severe pleural adhe- sion group was significantly higher than that in the none pleural adhesion group and in the mild pleural adhesion group （P 〈 0.05, respectively）. Conclusions The proportion of Thl cells and levels of INF-γ, and TNF-a are pos- itively related with pleural adhesion severity. Cellular immune response which is related with Th 1 cells contributes to pathological immune pleurai damage and intensify the severity of pleura1 adhesions.