不同结核病类型合并糖尿病患者治疗前后外周血免疫细胞亚群的动态变化

Dynamic changes of peripheral blood immune cell subsets before and after treatment in patients with different types of tuberculosis combined with diabetes mellitus

为研究不同结核病类型合并DM患者治疗前后外周血免疫细胞亚群的动态变化对治疗结局的影响,选择2017年3至10月的活动性肺结核合并DM患者36例(A组),潜伏结核感染合并DM患者36例(B组)。两组患者均进行降糖和抗结核治疗,对比两组患者DM和结核的治疗效果及治疗前后外周血免疫细胞亚群和炎性因子的变化情况。结果显示,两组患者在降糖治疗后空腹血糖和糖化血红蛋白水平较治疗前均有显著下降(P<0.05),两组患者治疗后空腹血糖和糖化血红蛋白水平比较,差异无统计学意义(P>0.05)。A组治疗后,痰菌转阴率为97.2%,治疗有效率为88.9%。A组和B组患者治疗后,结核T检验(detection of tuberculosis T cell,TB-IGRA)阳性率分别降至5.6%和2.8%。治疗前A组患者Th1和Th17水平显著高于B组(P<0.05),Th2和Treg水平显著低于B组(P<0.05);治疗后两组患者Th1和Th17水平较治疗前均显著降低,Th2和Treg水平显著升高(P<0.05);两组患者间治疗后Th1、Th2、Th17和Treg水平比较,差异均无统计学意义(P>0.05)。治疗前A组患者TNF-α和IFN-γ水平显著高于B组(P<0.05),IL-10和IL-4水平显著低于B组(P<0.05);治疗后两组患者TNF-α和IFN-γ水平较治疗前均显著降低,IL-10和IL-4水平显著升高(P<0.05);两组患者间治疗后TNF-α、IFN-γ、IL-10和IL-4水平比较,差异均无统计学意义(P>0.05)。提示外周血免疫细胞亚群的动态变化对结核病合并DM患者治疗结局的评价具有一定的参考价值。

We studied the effect of the dynamic changes of the peripheral blood immune cell subsets on the treatment outcome in the patients with different types of tuberculosis combined with DM.36 patients with active pulmonary tuberculosis combined with DM(group A),latent tuberculosis infection combined with DM(group B)were treated from March to October,2017.The treatment of DM and tuberculosis was performed in both groups,and the effect of treatment was compared between the two groups,and the changes of immune cell subsets and inflammatory factors in peripheral blood before and after the treatment were observed.The results showed after the blood sugar-lowering treatment,the fasting blood glucose and the glycosylated hemoglobin decreased significantly in both groups(P<0.05),and the fasting blood glucose and the glycosylated hemoglobin in the two groups had no significant difference(P>0.05).After the treatment of the group A,the conversion rate of bacteria in sputum was 97.2%,and the effective rate was 88.9%.After treatment,the positive rates of detection of tuberculosis T cell(TB-IGRA)in the group A and the group B were decreased to 5.6%and 2.8%,respectively.The levels of Th1 and Th17 in patients with the group A were significantly higher than those in the group B(P<0.05),and the levels of Th2 and Treg were significantly lower than those in the group B(P<0.05).After the treatment,the levels of Th1 and Th17 were significantly lower and the levels of Th2 and Treg were significantly higher than those before treatment(P<0.05),but there was no significant difference in the levels of Th1,Th2,Th17 and Treg between the two groups after treatment(P<0.05).Before treatment,the levels of TNF-αand IFN-γin the group A were significantly higher than those in the group B(P<0.05),IL-10 and IL-4 levels were significantly lower than those in the group B(P<0.05).The levels of TNF-αand IFN-γin both groups after treatment were significantly lower than those before treatment and the levels of IL-10 and IL-4 were significantly higher(P<0.05).There was no significant difference in the levels of TNF-α,IFN-γ,IL-10 and IL-4 between both groups(P>0.05).The study suggests that the dynamic change of the peripheral blood immune cell subsets is of great significance to the diagnosis and treatment outcome of the patients with tuberculosis combined with DM.