初治涂阴肺结核患者实验室指标特征分析

Analysis of Laboratory Index Characteristics in Newly Treated Smear-Negative Pulmonary Tuberculosis Patients

目的探究涂阴肺结核患者实验室检测指标特征与涂阳肺结核患者及健康人群之间的差异。方法研究对象选自2023年3—9月在云南省传染病医院就诊的50例初治肺结核患者,根据诊断划分为涂阴组22例和涂阳组28例,收集研究对象一般资料,采用流式细胞仪检测研究对象淋巴细胞亚群和细胞因子水平,比较各组间淋巴细胞亚群、细胞因子、血常规指标及生化指标之间的差异。结果涂阴组患者吸烟史、耐药肺结核、痰培养阳性、GeneXpert阳性及有肺部空洞的比例均显著低于涂阳组(P<0.05)。涂阴组PTB患者的CD45^(+)、CD3^(+)T、CD4^(+)T、CD8^(+)T和NK细胞计数显著低于健康对照组(P<0.05),CD45^(+)、CD3^(+)T、CD4^(+)T、CD8^(+)T和B细胞计数显著高于涂阳组PTB患者(P<0.05)。涂阴组PTB患者IL-1β、IL-6、IL-8、IL-10、IL-17和IFN-γ水平显著高于健康对照组,IL-12和IFN-α水平显著低于健康对照组(P<0.05);涂阴组PTB患者IL-2、IL-5、IL-6、IL-12、IL-17和IFN-γ水平显著低于涂阳组PTB患者(P<0.05)。涂阴组PTB患者中性粒细胞比、CRP和降钙素原水平显著高于健康对照组(P<0.05),红细胞、血红蛋白、总蛋白、白蛋白、白球比和前白蛋白水平显著低于健康对照组(P<0.05);涂阴组PTB患者单核细胞水平和单核细胞比例显著低于涂阳组PTB患者(P<0.05)。结论肺结核患者存在明显的免疫功能受损状态,与涂阴肺结核相比,痰涂片阳性肺结核患者的淋巴细胞亚群受损更为严重,细胞因子水平更高,感染程度也更加严重。

Objective To explore the differences in laboratory test index characteristics among smearnegative pulmonary tuberculosis patients,smear-positive pulmonary tuberculosis patients and healthy people.Methods Fifty patients with initial treatment of pulmonary tuberculosis in our hospital from March 2023 to September 2023 were selected and divided into a smear-negative group and a smear-positive group according to the diagnosis.The general data of the subjects were collected,and the lymphocyte subsets and cytokines levels of the subjects were detected by flow cytometry.The lymphocyte subsets,cytokines,blood routine indexes and biochemical indexes were compared among the groups.Results The proportions of smoking history,drugresistant tuberculosis,positive sputum culture,positive GeneXpert and pulmonary cavity in the smear-negative group were significantly lower than those in the smear-positive group(P<0.05).The counts of CD45^(+),CD3^(+)T,CD4^(+)T,CD8^(+)T and NK cells in PTB patients with negative smears were significantly lower than those in healthy controls(P<0.05).The counts of CD45^(+),CD3^(+),CD4^(+),CD8^(+)T and B cells were significantly higher than those of smear-positive PTB patients(P<0.05).The levels of IL-1β,IL-6,IL-8,IL-10,IL-17 and IFN-γin the smear-negative PTB group were significantly higher than those in the healthy control group,while the levels of IL-12 and IFN-αwere significantly lower than those in the healthy control group(P<0.05).The levels of IL-2,IL-5,IL-6,IL-12,IL-17 and IFN-γin PTB patients in the smear-negative group were significantly lower than those in the smear-positive group(P<0.05).The neutrophil ratio,CRP and procalcitonin levels of PTB patients in the smear-negative group were significantly higher than those in the healthy control group(P<0.05),and the red blood cell,hemoglobin,total protein,albumin,white blood cell ratio and prealbumin levels were significantly lower than those in the healthy control group(P<0.05).The level and proportion of monocytes in PTB patients in the smear-negative group were significantly lower than those in the smear-positive group(P<0.05).Conclusion Pulmonary tuberculosis patients have impaired immune function.Compared with smear-negative pulmonary tuberculosis patients,the lymphocyte subsets of sputum smear-positive pulmonary tuberculosis patients are more severely damaged,the levels of cytokines are higher,and the degree of infection is more serious.