非耐药和耐多药肺结核患者外周血T淋巴细胞亚群动态变化及临床意义

Dynamic Changes and Clinical Significance of Peripheral Blood T Lymphocyte Subsets in Patients with Non-Drug-Resistant and Multi-Drug-Resistant Pulmonary Tuberculosis

目的:探讨非耐药和耐多药肺结核患者外周血T淋巴细胞亚群动态变化及临床意义。方法:选取2020年1月至2021年6月该院收治的97例肺结核患者为研究对象,均进行耐药性检测,根据检测结果将患者分为耐多药组和非耐药组,两组患者均检测并对比外周血T淋巴细胞CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)和外周血Th1、Th2、Th17细胞亚群水平。耐多药组和非耐药组患者均进行抗结核治疗3个月,评价抗结核治疗效果并复查外周血T淋巴细胞亚群水平。结果:治疗前,耐多药组患者外周血T淋巴细胞CD3^(+)、CD4^(+)和CD4^(+)/CD8^(+)水平显著低于非耐药组,差异均有统计学意义(P<0.05);两组患者CD8^(+)水平比较,差异无统计学意义(P>0.05);耐多药组患者外周血Th1、Th2水平显著低于非耐药组,外周血Th17水平显著高于非耐药组,差异均有统计学意义(P<0.05)。非耐药组患者抗结核治疗预后良好率为77.59%(45/58),显著高于耐多药组的35.90%(14/39),差异有统计学意义(P<0.05)。与治疗前比较,非耐药组患者治疗后CD3^(+)、CD4^(+)和CD4^(+)/CD8^(+)水平均显著升高,差异均有统计学意义(P<0.05);而耐多药组患者治疗后CD3^(+)、CD4^(+)和CD4^(+)/CD8^(+)水平与本组治疗前比较,差异均无统计学意义(P>0.05)。与治疗前比较,非耐药组患者治疗后Th1、Th2水平显著升高,Th17水平显著降低,差异均有统计学意义(P<0.05);而耐药性组患者治疗后Th1、Th2和Th17水平与本组治疗前比较,差异均无统计学意义(P>0.05)。结论:肺结核患者存在明显的免疫功能受损状态,且耐多药肺结核患者的免疫功能受损状态更严重;结核分枝杆菌的耐药性会影响肺结核患者体内的免疫功能及抗结核治疗效果。

OBJECTIVE:To probe into the dynamic changes and clinical significance of peripheral blood T lymphocyte subsets in patients with non-drug-resistant and multi-drug-resistant pulmonary tuberculosis.METHODS:Totally 97 patients with pulmonary tuberculosis admitted into the hospital from Jan.2020 to Jun.2021 were extracted as the research objects.All patients were tested for drug resistance.According to the results,all patients were divided into multi-drug resistance group and non-drug resistance group.Peripheral blood T lymphocyte CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)ratio and peripheral blood Th1,Th2,Th17 cell subsets were detected and compared between two groups.Both the multi-drug-resistance group and the non-drug-resistance group received anti-tuberculosis treatment for 3 months,and the anti-tuberculosis treatment effect was evaluated and the levels of peripheral blood T lymphocyte subsets were re-examined.RESULTS:Before treatment,the peripheral blood T lymphocyte CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)ratio in the multi-drug-resistance group was significantly lower than that in the non-drug-resistance group,with statistically significant difference(P<0.05),and there was no significant difference in the level of CD8^(+)between two groups(P>0.05).Peripheral blood Th1 and Th2 in the multi-drug-resistance group were significantly lower than those in the non-drug-resistance group,and peripheral blood Th17 was significantly higher than that in the non-drug-resistance group,with statistically significant difference(P<0.05).The good prognosis rate of non-drug-resistance group was 77.59%(45/58),significantly higher than that of multi-drug-resistance group(35.90%,14/39),the difference was statistically significant(P<0.05).Compared with before treatment,CD3^(+),CD4^(+),CD4^(+)/CD8^(+)ratio in non-drug-resistance group increased significantly after treatment,with statistically significant difference(P<0.05).There were no significant differences in CD3^(+),CD4^(+),CD4^(+)/CD8^(+)ratio in the multi-drug-resistance group after treatment compared with those before treatment(P>0.05).Compared with before treatment,Th1 and Th2 in non-drug-resistance group increased significantly and Th17 decreased significantly after treatment,with statistically significant difference(P<0.05).However,there were no significant differences in Th1,Th2 and Th17 in the multi-drug-resistance group after treatment compared with those before treatment(P>0.05).CONCLUSIONS:Patients with pulmonary tuberculosis have significantly impaired immune status,which is more severe in patients with multi-drug-resistant pulmonary tuberculosis;drug resistance of Mycobacterium tuberculosis affects the immune status and the efficacy of anti-tuberculosis treatment in patients with pulmonary tuberculosis.