肺结核患者T辅助细胞、NKT细胞、NK细胞水平与疾病发展及预后的关系

Relationship between the levels of T helper cells, NKT cells, NK cells and disease development and prognosis in patients with pulmonary tuberculosis

目的研究肺结核患者T辅助细胞、自然杀伤T细胞(NKT细胞)、自然杀伤细胞(NK细胞)水平与疾病发展及预后的关系。方法选取2015年12月～2016年12月四川大学华西广安医院(以下简称"我院")收治的肺结核病患者100例,选取同期我院体检的健康者100例;根据初诊、复诊、结核菌素情况将其分为四组(Ⅰ～Ⅳ组分别为初诊肺结核组、复诊肺结核组、结合菌素阳性健康组、结合菌素阴性健康组)。使用流式细胞仪检测四组治疗前外周血T细胞、NKT、NK细胞表达率。结果与Ⅲ组比较,Ⅰ组患者NKT细胞表达率显著升高,差异有统计学意义(P <0.05),两组T细胞及NK细胞表达率差异无统计学意义(P> 0.05);与Ⅳ组比较,Ⅰ组患者NKT细胞表达率显著升高,差异有统计学意义(P <0.05),两组T细胞及NK细胞表达率差异无统计学意义(P> 0.05);与Ⅰ组比较,Ⅱ组患者T细胞表达率显著升高,差异有统计学意义(P <0.05),但两组NKT细胞及NK细胞表达率差异无统计学意义(P> 0.05);Ⅲ组及Ⅳ组在T细胞、NK、NKT细胞表达率差异无统计学意义(P> 0.05)。Ⅰ组患者中轻症、中症及重症亚组T细胞表达率差异有统计学意义(P <0.05),表达率:重症>中症>中轻症。三个亚组的NKT细胞及NK细胞表达率差异无统计学意义(P> 0.05)。100例肺结核患者治疗后均随访6个月,2例痰菌复阳,1例病灶恶化,其余均未复发。结论初诊患者T细胞表达水平与健康者相当,与疾病严重程度相关。复诊患者T细胞表达率明显升高。活动性结核患者中NKT细胞表达增加。因此,NK、T细胞测定可辅助诊断活动性结核。

Objective To study the relationship between the levels of T helper cells,natural killer T cells(NKT cell)natural killer cells(NK cell),and the development and prognosis of pulmonary tuberculosis.Methods A total of 100 cases of tuberculosis patients admitted to the West China-Guang′an Hospital of Sichuan University("our hospital"for short)from December 2015 to December 2016 were selected,and 100 healthy people in the same period were selected.According to the initial diagnosis and tuberculin status,they were divided into four groups(GroupsⅠ~Ⅳwere the newly dianosed tuberculosis group,retrospective tuberculosis group,tuberculin-positiue health group,tuberculin-negative health group).Flow cytometry was used to detect the expression rates of peripheral blood T cells,NKT and NK cells in the four groups before treatment.Results Compared with groupⅢ,the expression rate of NKT cells in groupⅠwas significantly increased,the difference was statistically significant(P<0.05).There was no significant difference in the expression rates of T cells and NK cells between the two groups(P>0.05).Compared with groupⅣ,the expression rate of NKT cells in groupⅠwas significantly increased,the difference was statistically significant(P<0.05).There was no significant difference in the expression rates of T cells and NK cells between the two groups(P>0.05);Compared with groupⅡ,the T cell expression rate was significantly increased,the difference was statistically significant(P<0.05),but there was no significant difference in the expression rate of NKT cells and NK cells between the two groups(P>0.05);groupⅢandⅣThere was no significant difference in the expression rate of T cells,NK and NKT cells(P>0.05).The expression rates of T cells in the mild,moderate and severe subgroups of groupⅠwere statistically significant(P<0.05),and the expression rate was:severe group>middle group>moderate mild group.There was no significant difference in the expression rates of NKT cells and NK cells between the three subgroups(P>0.05).A total of 100 patients with pulmonary tuberculosis were followed up for 6 months after treatment,2 cases of sputumre-yang,1 case of lesions worsened,and the rest did not relapse.Conclusion The level of T cell expression in newly diagnosed patients is comparable to that of healthy individuals and is associated with disease severity.The expression rate of T cells was significantly increased in the patients who were reviewed.NKT cell expression increased in active tuberculosis patients.Therefore,NK and T cell assays can aid in the diagnosis of active tuberculosis.