结核患者外周血中活化的淋巴细胞变化及意义

Changes and signiHcance of lymphocyte activation in peripheral blood of tuberculosis patients

目的研究结核患者外周血中活化的淋巴细胞水平与健康人群的差异及其临床价值;方法收集43例活动性肺结核APTB患者、25例潜伏性结核LTB患者及31例健康人(对照组)的外周血标本,采用流式细胞术检测其活化的淋巴细胞百分比并统计3组之间的差异。结果相较于LTB,APTB Treg细胞比例显著升高(P<0.01);相较于对照组,APTB和LTB CD3^(+)HLA-DR^(+)T、CD4^(+)HLA-DR^(+)T、CD8^(+)HLA-DR^(+)T细胞比例均明显升高(P<0.05),而CD8^(+)CD28^(+)T、NK细胞比例则显著降低(P<0.05);此外,APTB的CD4^(+)T与CD8^(+)T之比及Treg、CD16^(+)CD56^(+)CD69^(+)细胞比例也显著高于对照组(P<0.05)。通过ROC曲线和二元Logistic回归分析发现在鉴别APTB和对照组时,联合CD3^(+)HLA-DR^(+)T、CD4^(+)HLA-DR^(+)T与CD16^(+)CD56^(+)CD69^(+)细胞的ROC曲线下面积为0.904。结论外周血中活化的淋巴细胞水平检测可为结核病的诊断和鉴别活动性和潜伏性结核病提供实验室依据。

Objective To study the difference and clinical value of lymphocyte activation behveen peripheral blood of tuberculosis patients and healthy people.Methods Peripheral blood samples were collected from 43 active pulmonary tuberculosis patients(APTB),25 latent tuberculosis patients(LTB)and 31 healthy controls(HCs).Flow cytometry was applied to detect the percentage of activated lymphocytes among the three groups.Results As compared with the LTB patients,APTB patients had significantly higher percentage of Treg cells(P<0.01).As compared with the HCs,the APTB and LTB patients had significantly higher levels of CD3^(+)HLA-DR^(+)T,CD4^(+)HLA-DR^(+)T,CD8^(+)HLA-DR^(+)T cells and lower levels of CD8^(+)CD28^(+)T cells,NK cells(P<0.05).Meanwhile,when compared with HCs,APTB patients had higher levels of Treg cells,CD16^(+)CD56^(+)CD69^(+)cells and the level of CD4^(+)T/CD8^(+)T cell(P<0.05).In distinguishing APTB patients and HCs,the area under the ROC curve(AUC)of combined the CD3^(+)HLA-DR^(+)cells,CD4^(+)HLA-DR^(+)cells and CD16^(+)CD56^(+)CD69^(+)cells was 0.901.Conclusion The level of activated lymphocytes in peripheral blood can provide laboratory basis for the diagnosis and differentiation of active and latent tuberculosis.