CD4^(+)T细胞是影响QFT-GIT在矽肺合并肺结核患者中灵敏度下降的主要影响因素

CD4^(+)T Cells as the Main Factors of QFT-GIT Sensitivity Decrease inSilicosis Patients with Tuberculosis Infection

目的分析矽肺与QuantiFERON-TB Gold In-tube(QFT-GIT)检测结果的相关性,找出矽肺合并结核感染患者QFT-GIT检测灵敏度降低的主要因素,并探索其提高检出灵敏度的方法。方法收集结核杆菌培养阳性的矽肺病病例和单纯结核杆菌培养阳性的病例,进行QFT-GIT检测、流式细胞检测分析探索引起QFT-GIT在矽肺合并肺结核患者中灵敏度下降的主要原因,并利用CD4^(+)T细胞富集试验恢复QFT-GIT的敏感性。结果矽肺合并肺结核患者QFT-GIT灵敏度(60.0%)与单纯的肺结核患者(80.15%)相比明显降低(P=0.042),进一步在矽肺合并肺结核患者中分析QFT-GIT的灵敏度发现QFT-GIT阳性患者CD4^(+)T细胞的数量和比例高于阴性患者且阳性率与CD4^(+)T细胞数量呈正相关(P<0.01),在体外实验中同时增加CD4^(+)T细胞的数量可以恢复矽肺患者QFT-GIT的敏感性。结论首先发现矽肺合并肺结核患者存在QFT-GIT灵敏度下降的关系,进一步发现CD4^(+)T细胞可能是该现象产生的原因之一,同时,通过靶向增加CD4^(+)T细胞的数量可以恢复QFT-GIT的敏感性。这项研究为矽肺并发症的诊断及免疫疗法提供了理论上的依据,且对于临床诊断及治疗来说具有重要价值。

Objective To analyze the correlation between silicosis and QuantiFERON-TB Gold In-tube(QFT-GIT),and to identify the main causing factors of QFT-GIT sensitivity decrease in silicosis patients and to explore the method to improve the sensitivity.Methods Silicosis patients with positive results of tubercle bacillus culture and simple tuberculosis patients were collected for the study.QFT-GIT assays and flow cytometric were used to identify the causing factors of QFT-GIT sensitivity decrease in silicosis patients with tuberculosis infection.CD4^(+)T cells enrichment experiment was used to recover QFT-GIT sensitivity.Results The sensitivity of QFT-GIT test in silicosis patients with tuberculosis infection(60.0%)had a significantly decrease compared with the single pulmonary tuberculosis patients(80.15%).Furthermore,results showed the number of CD4^(+)T cells in TB&SILs group were significantly decreased,also the sensitivity was positively associated with the number of CD4^(+)T cells(P<0.01),and increased number of CD4^(+)T cells could recover QFT-GIT sensitivity.Conclusion This is the first study identifying the sensitivity of QFT-GIT test are decreased in the silicosis patients and an increased number of CD4^(+)T cells could recover the phenotype.This study provides a theoretical basis for the diagnosis and immunotherapy of silicosis and has an important value for its clinical diagnosis and treatment.