风湿性疾病并发肺结核患者的三种免疫学指标检测结果分析

Analysis of three immunological indicators in rheumatic patients complicated with pulmonary tuberculosis

目的探讨风湿性疾病并发肺结核患者的免疫学指标特点。方法搜集2017年7月至2019年7月解放军总医院第八医学中心全军结核病研究所明确诊断为风湿性疾病并发肺结核患者117例(观察组),采用系统抽样方法随机选取同时期诊断为单纯肺结核患者117例(对照组)进行研究。比较两组患者结核抗体检测阳性率、γ干扰素释放试验阳性率和T淋巴细胞亚群计数的差异。结果结核抗体38 kD+16 kD(1 kD=相对分子质量1000)和结核抗体381kD的检测中观察组患者阳性率[分别为6.84%(8/117)、21.37%(25/117)]均低于对照组患者的阳性率[分别为33.33%(39/117)、71.79%(84/117)],差异均有统计学意义(χ^2值分别为25.59、59.78,P值均为0.000)。观察组患者γ-干扰素释放试验阳性率为57.26%(67/117)与对照组患者阳性率[55.56%(65/117)]比较,差异无统计学意义(χ^2=0.70,P=0.792)。淋巴细胞亚群检测中观察组患者外周血CD4^+细胞计数的中位数(四分位数)[M(Q1,Q3)]为513.00(339.75,844.50)个/μl,CD4^+/CD8^+值的M(Q1,QM)为0.96(0.74,1.53),均高于对照组患者外周血CD4^+细胞绝对计数[M(Q1,Q3)为380.00(320.00,503.00)个/μl]和CD4^+/CD8^+值[M(Q1,Q3)为0.91(0.74,0.96)],两组间比较差异均有统计学意义(Z=211,P=0.035;Z=4.90,P=0.000)。而观察组外周血CD8+细胞计数[M(Q1,Q3)为377.50(193.00,528.50)个/μl]低于对照组[M(Q1,Q3)为475.00(410.00,524.00)个/μl],两组间比较差异有统计学意义(Z=2.27,P=0.023)。结论风湿性疾病并发肺结核患者结核抗体检测阳性率及外周血CD8^+细胞计数低于单纯肺结核患者,外周血CD4^+细胞计数高于单纯肺结核患者,γ-干扰素释放试验阳性率与单纯肺结核患者比较差异无统计学意义。

Objective To investigate the characteristics of immunological indicators of rheumatic patients complicated with pulmonary tuberculosis.Methods A total of 117 rheumatic patients complicated with pulmonary tuberculosis from PLA Institute of Tuberculosis,the 8 th Medical Center of Chinese PLA Hospital between July2017 and July 2019 were selected as the observation group,and 117 patients with pulmonary tuberculosis alone during the same period were randomly selected by systematic sampling method as the control group.The positive rate of TB antibody test,the positive rate of IGRA and the count of T lymphocyte subsets of the two groups were compared.Results The positive rates of TB antibody(38 kD+16 kD)(1 kD=1000 relative molecular mass)and TB antibody 38 kD in the observation group were significantly lower than those in the control group(6.84%(8/117)vs.33.33%(39/117),χ^2=25.59,P=0.000;21.37%(25/117)vs.71.79%(84/117),χ^2=59.78,P=0.000).The difference of positive rate of IGRA in two groups was not significant(57.26%(67/117)in the observation group and 55.56%(65/117)in the control group,χ^2=0.70,P=0.792).As to the detection of lymphocyte subsets,peripheral blood CD4^+cell count(median(quartiles))and CD4^+/CD8^+value(median(quartiles))in the observation group were significantly higher than those in the control group(513.00(339.75,844.50)/μl vs.380.00(320.00,503.00)/μl,Z=2.11,P=0.035;0.96(0.74,1.53)vs.0.91(0.74,0.96),Z=4.90,P=0.000).However,peripheral blood CD8^+cell count(median(quartile))in the observation group was significantly lower than that in the control group(377.50(193.00,528.50)/μl vs.475.00(410.00,52400)/μl,Z=2.27,P=0.023).Conclusion Compared to those of patients with pulmonary tuberculosis alone,the positive rate of TB antibody and CD8^+cell count in peripheral blood in rheumatic patients complicated with pulmonary tuberculosis were lower,while the CD4^+cell count in peripheral blood of rheumatic patients complicated with pulmonary tuberculosis was higher.The difference of positive rate of IGRA between rheumatic patients complicated with pulmonary tuberculosis and patients with tuberculosis alone was not significant.