肺结核88例外周血单核细胞中白细胞分化抗原36水平及其临床意义

The level of CD36 in peripheral blood mononuclear cells of 88 cases with pulmonary tuberculosis and its clinical significance

目的检测肺结核病人外周血单核细胞中白细胞分化抗原36(CD36)水平和血清中血脂的水平,并分析CD36与机体脂代谢的关系。方法本研究共纳入广安市人民医院2020年3月至2021年6月期间住院治疗的肺结核病人88例作为研究组,选取88例同期于该院进行体检的健康者作为对照组。研究组病人根据是否耐药分为非耐药肺结核(52例)和耐药肺结核(36例);根据痰涂片结果分为痰涂片阴性(40例)和痰涂片阳性(48例)。采用荧光定量PCR技术检测外周血单核细胞中CD36的表达水平,免疫比浊法测定血清三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白AI(ApoAI)、载脂蛋白B(ApoB)水平;Pearson法分析研究组CD36的表达水平与血脂水平的相关性;采用多元线性回归分析外周血单核细胞CD36表达水平的影响因素。结果研究组外周血单核细胞中CD36表达水平1.80±0.42显著高于对照组1.06±0.32(P<0.05),血清TG、TC、LDL-C、HDL-C、ApoAI和ApoB水平显著低于对照组(P<0.05)。耐药肺结核病人外周血单核细胞中CD36表达水平2.01±0.47显著高于非耐药肺结核1.65±0.39(P<0.05),血清TG、TC、LDL-C、HDL-C、ApoAI和ApoB水平显著低于非耐药肺结核(P<0.05)。痰涂片阳性病人外周血单核细胞中CD36表达水平1.97±0.45显著高于痰涂片阴性1.60±0.38(P<0.05),血清TG、TC、LDL-C、HDL-C、ApoAI和ApoB水平显著低于痰涂片阴性(P<0.05)。研究组外周血单核细胞CD36表达水平分别与血清中TG、TC、LDL-C、HDL-C、ApoAI和ApoB水平呈负相关(r=−0.55,P<0.05;r=−0.53,P<0.05;r=−0.68,P<0.05;r=−0.46,P<0.05;r=−0.50,P<0.05;r=−0.45,P<0.05)。多元线性回归分析结果显示,TG降低、HDL-C降低、ApoB降低是外周血单核细胞CD36表达水平的影响因素(P<0.05)。结论肺结核病人较健康人群,CD36水平较高,血脂水平较低,肺结核病人的CD36高表达影响脂代谢,对疾病的发生发展可能产生重要作用。

Objective To detect the level of leukocyte differentiation antigen CD36(CD36)in peripheral blood mononuclear cells and serum lipid levels in patients with pulmonary tuberculosis(PTB),and to analyze the relationship between CD36 and lipid metabolism.Methods Eighty-eight patients with PTB,who were hospitalized in Guang'an Municipal People's Hospital from March 2020 to June 2021,were included in this study as the study group,and 88 healthy people who underwent physical examination in the same hospital were chosen as the control group.The patients in the study group were assigned into non drug resistant PTB group(n=52)and drug resistant PTB group(n=36);according to the results of sputum smear,it was assigned into negative sputum smear group(n=40)and positive sputum smear group(n=48).The expression level of CD36 in peripheral blood mononuclear cells was determined by fluorescence quantitative PCR,the serum triglyceride(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),apolipoprotein AI(ApoAI),and apolipoprotein B(ApoB)levels were determined by immunoturbidimetry.The correlation between the expression level of CD36 and blood lipid level in study group was analyzed by Pearson method.Multiple linear regression was used to analyze the influencing factors of CD36 expression in peripheral blood monocytes.Results The expression level of CD36 in peripheral blood monocytes of the study group was significantly higher than that of the control group[(1.80±0.42)vs.(1.06±0.32),P<0.05],and the levels of serum TG,TC,LDL-C,HDL-C,ApoAI and ApoB in the study group were significantly lower than those in the control group(P<0.05).The expression level of CD36 in peripheral blood monocytes of drug-resistant PTB patients was significantly higher than that of non drug-resistant PTB ones[(2.01±0.47)vs.(1.65±0.39),P<0.05],and the levels of serum TG,TC,LDL-C,HDL-C,ApoAI and ApoB were significantly lower than those of non drug-resistant PTB patients(P<0.05).The expression level of CD36 in peripheral blood monocytes of patients with sputum smear-positive TB was significantly higher than that of patients with sputum smear-negative TB[(1.97±0.45)vs.(1.60±0.38),P<0.05],and the levels of serum TG,TC,LDL-C,HDL-C,ApoAI and ApoB were significantly lower than those of patients with sputum smear-negative TB(P<0.05).The expression level of CD36 in peripheral blood mononuclear cells of the study group were inversely correlated with the levels of serum TG,TC,LDL-C,HDL-C,ApoAI and ApoB respectively(r=−0.55,P<0.05;r=−0.53,P<0.05;r=−0.68,P<0.05;r=−0.46,P<0.05;r=−0.50,P<0.05;r=−0.45,P<0.05).Multiple linear regression analysis results showed that the decreased TG,HDL-C and ApoB were the influencing factors of CD36 expression in peripheral blood monocytes(P<0.05).Conclusion As compared with healthy people,PTB patients have higher level of CD36 and lower level of blood lipids.The high expression of CD36 in PTB patients affects lipid metabolism and may play an important role in the occurrence and development of the disease.