氟康唑对老年肺结核合并肺部真菌感染患者临床结局和免疫反应的影响

Effects of Fluconazole on the Clinical Outcome and Immune Response in Elderly Patients with Pulmonary Tuberculosis Complicated with Pulmonary Fungal Infection

目的分析氟康唑对肺结核合并肺部真菌感染患者临床结局和免疫反应的影响。方法选取我院合并肺部真菌感染的261例老年肺结核患者,随机分为氟康唑组(131例)与安慰剂组(130例)。氟康唑组予以氟康唑治疗,安慰剂组予以安慰剂治疗。通过自动血液分析仪计算外周嗜酸性粒细胞计数,采用酶联免疫吸附测定试剂盒测定分泌型炎性细胞因子IFN-γ、肿瘤坏死因子(TNF)-α和趋化因子(C-X-C基序)配体(CXCL)9、CXCL10、CXCL11,通过流式细胞术分析外周血辅助性T细胞(Th)1和调节性T细胞(Treg)群体。比较两组患者治疗后结核病(TB)评分、外周血嗜酸性粒细胞数量;治疗后血清IFN-γ、TNF-α、Th1、CXCL9、CXCL10和CXCL11水平。结果治疗后,安慰剂组和氟康唑组患者基线TB评分比较,差异无统计学意义(P>0.05);氟康唑组患者外周血嗜酸性粒细胞数量较安慰剂组显著增加(P<0.05);氟康唑组患者的血清IFN-γ、TNF-α、Th1、CXCL9、CXCL10和CXCL11水平均较安慰剂组显著上调(P<0.05)。结论肺部真菌感染显著影响了老年肺结核患者患病期间的宿主免疫力,给予氟康唑治疗,有效地逆转了宿主免疫力。

Objective To analyze the effect of fluconazole on the clinical outcome and immune response in elderly patients with pulmonary tuberculosis complicated with pulmonary fungal infection.Methods A total of 261 elderly pulmonary tuberculosis patients with lung fungal infections in our hospital were selected and randomly divided into fluconazole group(131 cases)and placebo group(130 cases).The fluconazole group was treated with fluconazole,and the placebo group was treated with placebo.Calculate peripheral eosinophil count by automatic blood analyzer.The secretory inflammatory cytokine interferon(IFN)-γ,tumor necrosis factor(TNF)-αand chemokine(C-X-C motif)ligand(CXCL)9,CXCL10,CXCL11.Analyze the peripheral blood helper T cell(Th)1 and regulatory T cell(Treg)populations by flow cytometry for detection.The tuberculosis(TB)scores and the number of eosinophils in peripheral blood after treatment;serum IFN-γ,TNF-α,Th1,CXCL9,CXCL10 and CXCL11 levels after treatment were compared between the two groups.Results After treatment,there was no statistically significant difference between the placebo group and the fluconazole group in baseline TB scores(P>0.05).The number of peripheral blood eosinophils in the fluconazole group was significantly higher than that in the placebo group(P<0.05).The levels of serum IFN-γ,TNF-α,Th1,CXCL9,CXCL10 and CXCL11 in the fluconazole group were significantly higher than those in the placebo group(P<0.05).Conclusion Pulmonary fungal infection significantly affects the host immunity during the illness of elderly pulmonary tuberculosis patients,and give fluconazole treatment,effectively reverses the host immunity.