Cooperation between accessory cells and T lymphocytes in patients with tuberculous pleurisy

We studied interleukin 1 (IL-1) activity of pleural fluid macrophages and peripheral blood monocytes obtained from ten patients with tuberculous pleurisy and ten patients with malignant pleurisy, using purified protein derivative (PPD) as a stimulating agent. Tuberculous pleural fluid macrophages and peripheral blood monocytes tended to produce higher IL-1 activity than malignant pleural fluid macrophages and blood monocytes and showed significantly more IL-1 activity than healthy control monocytes. However, no significant difference in IL-1 activity was observed between tuberculous pleural macrophages and blood monocytes. With the cooperation of these accessory cells, pleural fluid T lymphocytes in patients with tuberculous pleurisy showed a significant level of interleukin 2 (IL-2) activity in the presence of PPD. Tuberculous pleural fluid macrophages promoted greater IL-2 production than blood monocytes from either tuberculous pleural fluid or blood T lymphocytes despite relative equivalence in measured IL-1 production. Combination of tuberculous pleural fluid macrophages and pleural fluid T lymphocytes was the most effective for increasing IL-2 activity when compared with other combinations. These results suggest that tuberculous pleural fluid macrophages and T lymphocytes may contribute to the immunopathogenesis of tuberculosis at a local site of disease.     

Lymphocyte proliferation and gamma-interferon production after "in vitro" stimulation with PPD. Differences between tuberculous and nontuberculous pleurisy in patients with positive tuberculin skin test

T-lymphocytes previously sensitized by an antigen undergo blastic transformation and produce IFN tau when stimulated by the same antigen. We studied the lymphoblastic response to PPD and IFN tau production in pleural fluid and peripheral blood of 41 patients (15 with tuberculous pleural effusion, 13 with nontuberculous pleurisy and positive tuberculin skin test, and 13 with tuberculin-negative nontuberculous pleurisy). In tuberculous pleuritis, pleural lymphocyte blastic response and IFN tau production were higher than those of peripheral lymphocytes, whereas in tuberculin-positive nontuberculous patients, peripheral lymphocyte response and IFN tau production were higher than those of pleural lymphocytes. Tuberculous pleural fluid lymphocytes underwent greater blastic transformation and produced more IFN tau than pleural lymphocytes of tuberculin-positive nontuberculous patients, whereas the opposite occurred in peripheral lymphocytes. In tuberculin-negative nontuberculous patients, there was no lymphoblastic response in either the pleural fluid or peripheral blood. These results concur with the concept of immunologic compartmentalization. In tuberculous pleuritis, there would be clonal expansion of PPD-responding T-lymphocytes in the pleural compartment. This expansion of PPD-specific lymphocytes would not occur in nontuberculous pleuritis, but lymphocytes sensitized to other antigens would accumulate in the pleural compartment.     

High level of interferon gamma in tuberculous pleural effusion

It has been observed that T-lymphocytes of patients with tuberculosis produce interferon gamma (IFN gamma) in vitro. Based on this idea, we studied IFN gamma in pleural fluid and serum. We studied 80 patients with pleural effusion; 30 patients with tuberculous pleurisy had high IFN gamma concentrations in pleural fluid. Patients with malignant pleural effusions, nonspecific pleural effusion, parapneumonic effusions and pleural transudates had low levels. The IFN gamma levels were higher in those with massive tuberculous effusion and apparent pulmonary lesion on x-ray film. We found that the T4/T8 lymphocyte ratio was higher in pleural fluid than in peripheral blood. Numbers of T3 and T4 lymphocytes were higher in tuberculous pleural effusions compared with those in other patients. There is no correlation between IFN gamma levels and lymphocyte subsets in pleural effusion. Perhaps pleural T-lymphocytes produce IFN gamma after stimulation by mycobacterial antigens and this lymphokine activates macrophages, increasing their bactericidal activity against Mycobacterium tuberculosis.     

Tuberculous pleural effusions. Evidence for selective presence of PPD-specific T-lymphocytes at site of inflammation in the early phase of the infection

Patients with tuberculous pleural effusions may show cutaneous anergy to tuberculin purified-protein derivative (PPD). This phenomenon has been attributed either to preferential sequestration of antigen-specific T-lymphocytes to the pleural space or to the presence of suppressor monocytes in the blood. In 2 patients with primary tuberculous infection involving the pleura and with skin anergy to PPD, the in vitro proliferation of pleural and peripheral blood T-cells to PPD was evaluated. Although peripheral blood T-cells were not reactive, pleural T-cells showed a marked proliferative response to PPD. At least in the first patient, the lack of proliferation of circulating T-cells could not be related to the presence of suppressor monocytes. Interestingly, after 4 to 8 wk of specific chemotherapy, PPD skin test became positive and the blood T-lymphocytes responded in vitro to the same antigen. Pleural T-lymphocytes were used to generate long-term, PPD-specific T-cell lines and could be maintained in vitro for more than 3 months with repeated cycles of stimulation. The pleural and the blood T-lymphocytes and the T-cell lines were also characterized phenotypically: although the majority of the T-lymphocytes present in the pleural space after Mycobacterium tuberculosis infection were Leu-3-positive (helper T-cells), T-cell lines proliferating in response to PPD included high numbers of Leu-2-positive cells (suppressor/cytotoxic T-cells). These data suggest that early skin anergy in tuberculous pleurisy may be associated with sequestration of PPD-reactive T-lymphocytes in the pleural spaces involving both Leu-2-and Leu-3-positive T-cells.     

胸水M1/M2型巨噬细胞比例在结核性胸膜炎与恶性胸腔积液鉴别中的价值

目的 探讨巨噬细胞极化在结核性胸膜炎与恶性胸腔积液鉴别中的价值.方法 前瞻性收集2018年10月至2019年9月到我院就诊的新发结核性胸膜炎或恶性胸腔积液患者,在治疗前采集胸腔积液与外周血,流式细胞术检测M1型(CD14+CD86+)与M2型(CD14+CD163+)单核巨噬细胞.并测定外周血细胞计数、血沉、γ-干扰素...     

结核性和恶性胸膜炎患者VEGF的水平及意义

目的 通过检测结核性胸膜炎及恶性胸膜炎患者血清和胸水中血管内皮生长因子（VEGF）含量,分析VEGF在两组患者血清、胸水中的差异,探讨VEGF在二者中的意义和诊断价值.方法 对确诊结核性胸膜炎和恶性胸膜炎各30例的患者在同一日留取胸水标本10 ml及静脉血5 ml,采用双抗体夹心酶联免疫吸附试验检测患者胸水及血清中VEGF水平,分析其差异及相关性.结果 结核组血清和胸水VEGF检测值分别为（45.33±18.33） ng/L、（62.73±24.65） ng/L;恶性组血清和胸水VEGF检测值分别为（66.00±29.83） ng/L、（95.54±42.11） ng/L;恶性组血清及胸水中VEGF含量均高于结核组（t值分别为3.9、5.2,P值均＜0.05）.VEGF在两组的血清和胸水中均呈正相关性（r值分别为0.53、0.38,P值均＜0.05）.结论 在结核性胸膜炎及恶性胸膜炎患者血清、胸水中VEGF水平有差异,恶性高于结核性;两组患者胸水中VEGF含量均高于血清,胸水VEGF含量随着血清VEGF含量增高而增高.检测胸腔积液患者血清和胸水中VEGF含量对结核性胸膜炎和恶性胸膜炎的诊断和鉴别诊断有一定的价值.     

Diagnostic accuracy of T-cell interferon-γ release assays in tuberculous pleurisy: a meta-analysis

Background and objective: The diagnosis of tuberculous pleurisy by analysis of pleural fluid using standard diagnostic tools is difficult. Recently, T‐cell interferon‐γ release assays (IGRA) have been introduced for the diagnosis of tuberculous pleurisy. The aim of the present meta‐analysis was to establish the overall diagnostic accuracy of IGRA on both pleural fluid and peripheral blood, for diagnosing tuberculous pleurisy. Methods: A systematic review was performed of English language publications. Sensitivity, specificity and other measures of the accuracy of IGRA for the diagnosis tuberculous pleurisy using both pleural fluid and blood were pooled using a random‐effects model or a fixed‐effects model. Receiver operating characteristic curves were used to summarize overall test performance. Results: Seven out of eight studies met the inclusion criteria. The summary estimates of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value and diagnostic odds ratio were, for pleural fluid: 0.75, 0.82, 3.49, 0.24, 0.85, 0.70 and 19.04, respectively; and for blood: 0.80, 0.72, 2.86, 0.28, 0.78, 0.74 and 11.06, respectively. Conclusions: As almost 20% of non‐tuberculosis patients would be erroneously treated for tuberculosis and 25% of patients with tuberculous pleurisy would be missed, pleural fluid IGRA are not useful for the clinical diagnosis of tuberculous pleurisy.     

Significance of the frequency of CD4+CD25+CD127- T-cells in patients with pulmonary tuberculosis and diabetes mellitus

Background and objective: Pulmonary tuberculosis and diabetes mellitus (DM) are closely associated. The objective of this study was to determine whether the expression of CD4+CD25+CD127? T‐cells (regulatory T‐cells (Treg)) is associated with diabetic pulmonary tuberculosis. Methods: Flow cytometry was used to determine the frequencies of CD4+CD25+ and CD4+CD25+CD127? T‐cells in peripheral blood, bronchoalveolar lavage fluid (BALF) and pleural effusions from 120 patients (30 with pulmonary tuberculosis and DM (TBDM), 30 with pulmonary tuberculosis without DM (TB), 30 with tuberculous pleurisy without DM (TBP) and 30 healthy volunteers). The concentrations of interferon (IFN)‐γ and interleukin (IL)‐10 in BALF and pleural effusions were determined by enzyme‐linked immunosorbent assay. Results: Treg frequencies in peripheral blood were significantly higher in patients with TBDM, TB and TBP than in the control group, with the frequency in TBDM being the highest (P < 0.01 for all). In TBP patients, Treg frequencies were significantly lower in pleural effusions than in peripheral blood. In TB patients, Treg frequencies in BALF and peripheral blood were not significantly different. However, in TBDM patients, Treg frequencies were significantly higher in BALF than in peripheral blood. IL‐10 expression was significantly higher, and IFN‐γ expression was significantly lower in BALF of TBDM patients compared with BALF and pleural effusions of TB patients. Conclusions: In patients with pulmonary tuberculosis and DM, the imbalance between Treg and effector T‐cells at pathological sites may be associated with weakened immunity and clinical manifestations of TB.     

结核性胸膜炎患者DNA氧化损伤和脂质过氧化的研究

目的　探讨结核性胸膜炎患者单个核细胞DNA氧化损伤和脂质过氧化的程度。方法采用单细胞凝胶电泳的方法检测 2 8例结核性胸膜炎患者 (试验组 )胸腔积液和外周血单个核细胞DNA损伤及 2 5名健康人 (对照组 )外周血单个核细胞DNA损伤 (以彗星率表示 ) ;采用菲罗啉比色法检测患者胸腔积液和血浆总抗氧化能力及健康人血浆总抗氧化能力 ;硫代巴比妥酸比色法检测患者及健康人血浆丙二醛 (MDA)含量。组间差异显著性比较采用t检验。结果　试验组胸腔积液单个核细胞彗星率为 (4 1 3± 14 5 ) % ,高于其外周血单个核细胞的 (2 1 2± 4 2 ) % (P <0 0 1) ;胸腔积液总抗氧化能力为 (5 172± 1195 )U/L ,显著低于其血浆的 (86 5 6± 15 92 )U/L(P <0 0 1)。胸腔积液单个核细胞彗星率与总抗氧化能力呈负相关 (r=- 0 4 2 5 ,P <0 0 5 )。试验组外周血单个核细胞彗星率及血浆MDA含量为 (2 1 2± 4 2 ) %和 (8 2 5± 1 37) μmol/L ,分别高于对照组的 (8 9± 3 7) %和(4 4 6± 0 93) μmol/L(P均 <0 0 1) ;试验组血浆总抗氧化能力为 (86 5 6± 15 92 )U/L ,显著低于对照组的 (10 6 10± 1399)U/L (P <0 0 1)。试验组血浆总抗氧化能力分别与外周血单个核细胞彗星率、血浆MDA含量呈负相关 (r分别为 - 0 4 38、-     

NK cells in carcinomatous and tuberculous pleurisy. Phenotypic and functional analyses of NK cells in peripheral blood and pleural effusions

To compare local immunity with that in peripheral blood, we examined 14 patients with carcinomatous pleurisy and 22 patients with tuberculous pleurisy by phenotypic and functional analyses of NK cells. We calculated the proportions of NK cells by means of anti-Leu 7 and anti-Leu 11 mAbs and the rates of NK cell activity by means of K 562. The percentages of Leu 7+ and Leu 11+ cells in both carcinomatous and tuberculous pleural effusions were lower than those in peripheral blood; however, there was no difference between carcinomatous and tuberculous pleural effusions in the proportions of Leu 11+ cells. The NK cell activity in tuberculous pleural effusions was the same as that in peripheral blood, while in carcinomatous pleural effusions, NK cell activity was lower than in peripheral blood; however, NK cell activity was much higher in tuberculous than in carcinomatous pleural effusions. Our study offers some pathophysiologic insight into the responses of NK cells to cancer and to tuberculosis in relation to peripheral blood and pleural effusion.     

TaqMan-PCR技术诊断结核病的临床应用研究

目的　探讨TaqMan-聚合酶链反应 (TaqMan-PCR)技术在结核病快速诊断中的临床价值。方法 对 155例活动性肺结核患者的痰和外周血、130例结核性胸膜炎患者的胸腔积液和外周血以及 61例结核性脑膜炎患者的脑脊液和外周血应用TaqMan -PCR检测结核分支杆菌DNA ,痰、胸腔积液和脑脊液进行抗酸染色涂片检查 ,另外 ,痰标本还进行了BACTEC和改良罗氏培养；同期以52例肺癌患者的痰和外周血、50例恶性胸腔积液患者的胸腔积液以及 33例健康人的外周血作为对照进行TaqMan-PCR检测。 结果 155例活动性肺结核患者的痰和外周血、130例结核性胸膜炎患者的胸腔积液和外周血以及 61例结核性脑膜炎患者的脑脊液和外周血TaqMan-PCR的阳性率分别为 49.0%和 51.6%、45.4%和 38.5%以及 50.8%和 42.6% ,痰、胸腔积液和脑脊液TaqMan-PCR的阳性率显著高于抗酸染色涂片以及BACTEC和罗氏培养 (P＜0.05)。TaqMan-PCR检测痰、胸腔积液和外周血的特异性分别为 96.2%、98%和 96.5%。结论 TaqMan-PCR具有较高的敏感性和特异性 ,对结核病的快速诊断具有一定的价值。     

Clinical immunology of tuberculosis

The standard tuberculin skin test has been known as the prototype of delayed type hypersensitivity testing which is mediated by T cells and macrophages and plays an important role in the pathogenesis of tuberculosis. Tuberculosis is indeed a chronic infectious disease, but variation in the host immune responses to tubercle bacilli results in the various clinical manifestations of the disease ranging from an immunologically hyperreactive state observed in pleural fluid lymphocytes in tuberculous pleurisy to an almost totally unresponsive state observed in those severely ill with refractory tuberculosis. In tuberculous pleurisy, T cells in pleural fluid respond remarkably in vitro to PPD tuberculin whereas T cells in peripheral blood responded poorly to PPD stimulation. Compartmentalization of PPD-reactive T cells in the pleural fluid and immunosuppression by T cells and/or macrophages in the peripheral blood were responsible for this immunological difference observed between the lymphocytes in pleural fluid and those in peripheral blood of tuberculous pleurisy. In advanced, drug-resistant tuberculosis as well as in nontuberculous mycobacterial infection, the proliferative responses of T cells in vitro to PPD stimulation were impaired. This depressed T cell response was due to depressed interleukin-2 (IL-2) production and not due to depressed IL-2 responsiveness. Therefore, the addition of exogenous IL-2, returned the depressed PPD-induced lymphocyte proliferation in vitro in these patients to the level of the response observed in lymphocytes from patients with newly-diagnosed tuberculosis. Our results suggest that recombinant IL-2 offers a novel approach to the therapy of advanced, drug-resistant tuberculosis and nontuberculous mycobacterial infection. Preliminary clinical trials of immunotherapy with recombinant IL-2 reveals the effectiveness of this therapy and encourages us to extend the trial to a larger scale. Tubercle bacilli have various biological activities. Research on tuberculosis and tubercle bacilli have contributed much to the progress of biochemistry, pathology and immunology. Mycobacterium is a fascinating organism, which now presents another big appeal to those studying immunology: Study of immunological interaction between gamma delta T cells and the highly conserved protein in mycobacteria, HSP, heat shock protein will contribute to the elucidation of the mechanism of immunological surveillance and the mechanism of autoimmune diseases. In addition, it will also contribute to the development of a new mycobacterial vaccine which will give direct, protective immunity against tuberculosis.     

MTB分泌蛋白抗原85B-早期分泌靶抗原6融合蛋白对结核性胸膜炎的辅助诊断价值

目的 研究MTB分泌蛋白抗原85B(Ag85B)-早期分泌靶抗原6(ESAT6)融合蛋白在结核性胸膜炎辅助诊断中的价值。方法 研究对象为2014年1月至2015年1月于河北省胸科医院住院的结核性胸膜炎(结核组)患者45例,非结核性胸膜炎(非结核组)患者26例,以及体检健康人群(健康组)25名。应用流式细胞仪分别检测结核分枝杆菌Ag85B-ESAT6融合蛋白刺激前后结核组、非结核组外周血、胸腔积液及健康组外周血中γ干扰素(IFN-γ)的含量,采用免疫组织化学染色法检测结核组与非结核组患者组织(通过手术或穿刺活检获得的胸膜组织)中CD4 ⁺和CD8 ⁺细胞的表达水平。采用SPSS 13.0软件进行统计学处理,数据符合正态分布的组间比较采用t检验,以P<0.05为差异有统计学意义。 结果 MTB Ag85B-ESAT6融合蛋白刺激前后,结核组外周血中IFN-γ的含量分别为(42.63±10.51)pg/ml和(401.90±72.54)pg/ml;非结核组分别为(38.97±7.08)pg/ml和(40.04±6.80)pg/ml;健康组分别为(39.61±7.28)pg/ml和(39.86±6.97)pg/ml。结核组胸腔积液中IFN-γ的含量分别为(411.91±41.56)pg/ml和(1342.67±167.96)pg/ml;非结核组分别为(47.99±11.49)pg/ml和(48.76±11.25)pg/ml。刺激前结核组胸腔积液中IFN-γ的含量明显高于非结核组,两组比较差异有统计学意义(t=55.194,P=0.000);刺激后结核组外周血单个核细胞产生的IFN-γ含量相对于刺激前及刺激后的其他两组比较,差异均有统计学意义(t=32.879、33.211和33.204,P值均为0.000);刺激后结核组与刺激前及非结核组刺激前后胸腔积液中IFN-γ的含量比较,差异均具有统计学意义(t=36.085、51.478和51.499,P值均为0.000)。免疫组织化学染色结果显示结核组与非结核组患者胸膜组织中的CD4 ⁺和CD8 ⁺积累光密度值(结核组:16349.91±2376.36和10525.77±1164.86;非结核组:1853.64±670.40和1327.15±175.55)差异均具有统计学意义(t=14.381和19.127,P值均为0.000)。 结论 结核分枝杆菌Ag85B-ESAT6融合蛋白刺激外周血和胸腔积液后均明显提高结核特异性IFN-γ的含量,对结核性胸膜炎的辅助诊断有较高的临床应用价值。     

Cytokine content in pleural effusion. Comparison between tuberculous and carcinomatous pleurisy

Tuberculous pleurisy is a good model for resolution of local cellular immunity. It would be expected that tuberculous pleural fluid contains a variety of immunologically important cytokines because of the accumulation of immunocompetent cells in the pleural cavity. We studied interleukin 1 (IL-1), interleukin 2 (IL-2), and interferon gamma (IFN-gamma) levels in pleural fluid of 20 patients with tuberculous pleurisy and compared them with those in pleural fluid of 20 patients with malignant pleurisy. We also evaluated adenosine deaminase (ADA) levels in both effusions. Tuberculous pleural fluid had higher levels of IL-1, IL-2, IFN-gamma, and ADA than malignant pleural fluid. Although the difference of IL-1 level between tuberculous and malignant pleural fluid was modest, that of IL-2, IFN-gamma, and ADA was dominant. These findings suggest that activated T lymphocytes in tuberculous pleural fluid concern the production of lymphokines at the morbid site and they effectively exert local cellular immunity through the action of such lymphokines.     

结核性胸膜炎胸液T淋巴细胞亚群、黏附分子变化分析

目的回顾性分析结核性胸膜炎时胸膜腔局部的免疫反应和炎症状态。方法利用单克隆抗体、采用流式细胞仪测定35例结核性胸膜炎患者外周血和胸液中表面标记CD3、CD4、CD8I、CAM-1、23、、VCAM-1的淋巴细胞、进行比较。结果胸液中CD3、CD4类淋巴细胞及亚群CD4/CD8比值明显高于外周血,而CD8淋巴细胞则明显低于外周血。黏附分子ICAM-12、3、、VCAM-1在外周血和胸液中淋巴细胞表面表达比例并无差异。黏附分子和T淋巴细胞亚群的以上分布情况在病程不同的患者中无差异性。结论结核性胸膜炎胸腔积液中以CD4淋巴细胞反应为主,而淋巴细胞表面黏附分子表达则无明显变化。     

胸水ADA、TB-DNA联合检测在结核性胸膜炎中的诊断运用

目的分析胸水ADA、TB-DNA联合检测对结核性胸膜炎诊断运用价值。方法对我院收治的结核性胸膜炎患者183例、癌性胸水患者65例以及炎性胸水患者49例作为研究对象,分别进行ADA、TB-DNA的检测,并对ADA、TB-DNA在三种疾病中的阳性率以及对结核性胸膜炎的敏感度、特异性以及准确性进行分析。结果结核性胸膜炎患者的ADA含量(72.3±23.2 IU/L)明显高于炎性胸水患者(38.4±12.9 IU/L)以及癌性胸水患者(24.3±6.5 IU/L);ADA、TB-DNA联合检测对结核性胸膜炎的特异性84.2%,敏感性98.91%以及准确性为93.26%。结论对结核性胸膜炎患者采用胸水ADA、TB-DNA联合检测可明显提高其检出率,并有助于对结核性胸膜炎胸水、癌性胸水以及炎性胸水的鉴别。     

结核性胸膜炎患者胸液中CD4~+ CD25~+ FoxP3~+调节T细胞抑制抗结核免疫

目的研究结核性胸膜炎患者胸液中CD4+CD25+FoxP3+调节T细胞是否增多,这些调节T细胞是否抑制结核的特异细胞免疫反应。方法使用细胞分离、流式细胞分析及体外细胞培养作细胞增殖及增殖抑制等实验方法,对15例结核性胸膜炎患者及17例健康正常人群胸液及外周血白细胞中CD4+CD25+FoxP3+调节T细胞的量及特征作研究。结果结核性胸膜炎患者胸液中CD4+CD25+FoxP3+调节T细胞明显高于患者及健康人群外周血。在体外,结核性胸膜炎患者胸液中单核细胞对BCG刺激产生γ-干扰素(IFN-γ)的能力明显强于患者及健康人群外周血中单核细胞;把这些调节T细胞从胸液单核细胞中清除,增强了结核患者胸液单核细胞对BCG刺激产生IFN-γ;从结核患者胸液分离的这些调节T细胞能抑制结核患者Th1细胞产生IFN-γ。结论结核性胸膜炎患者胸液CD4+CD25+FoxP3+调节T细胞增多,抑制结核性胸膜炎患者Th1细胞免疫反应,从而参与了结核性胸膜炎的发病。     

结核性胸膜炎胸液T淋巴细胞亚群、黏附分子变化分析

目的回顾性分析结核性胸膜炎时胸膜腔局部的免疫反应和炎症状态。方法利用单克隆抗体、采用流式细胞仪测定35例结核性胸膜炎患者外周血和胸液中表面标记CD3、CD4、CD8、ICAM-1、2、3、VCAM-1的淋巴细胞、进行比较。结果胸液中CD3、CD4类淋巴细胞及亚群CIM／CD8比值明显高于外周血，而CD8淋巴细胞则明显低于外周血。黏附分子ICAM-1、2、3、VCAM-1在外周血和胸液中淋巴细胞表面表达比例并无差异。黏附分子和T淋巴细胞亚群的以上分布情况在病程不同的患者中无差异性。结论结核性胸膜炎胸腔积液中以CD4淋巴细胞反应为主，而淋巴细胞表面黏附分子表达则无明显变化。     

结核性胸膜炎患者外周血CD4CD25调节性T细胞水平及Foxp3mRNA表达的分析

目的观察结核性胸膜炎患者外周血单个核细胞（PBMCs）中CD4 CD25调节性T细胞(CD4 CD25 Treg)水平及Foxp3 mRNA表达的变化,探讨CD4 CD25 Treg在结核性胸膜炎发病中的作用。方法采用流式细胞仪检测58例结核性胸膜炎患者和51例健康志愿者（正常对照组）PBMCs中CD4 CD25 Treg的比例;RT-PCR检测PBMCs中Foxp3 mRNA的表达。结果结核性胸膜炎患者PBMCs中CD4 CD25 Treg的比例明显高于正常对照组(P<0.05);Foxp3 mRNA的表达明显高于正常对照组(P<0.05)。 结论结核性胸膜炎患者外周血中具有免疫抑制活性CD4 CD25 Treg的数量增加,功能增强,可能是结核性胸膜炎发生发展的一个因素。     

结核性胸膜炎合并2型糖尿病患者外周血及胸腔积液结核感染T细胞斑点试验检测结果的对比研究

目的: 探讨合并2型糖尿病对结核性胸膜炎患者外周血及胸腔积液结核感染T细胞斑点试验(T-SPOT.TB)检测结果的影响。方法: 收集2016—2021年西安市胸科医院收治的诊断为结核性胸膜炎的444例患者,依据是否合并2型糖尿病,分为结核性胸膜炎合并2型糖尿病组(合并糖尿病组;116例)和未合并糖尿病的结核性胸膜炎组(非糖尿病组;328例)。分别采集两组患者抗结核药物治疗前胸腔积液和外周血标本,进行T-SPOT.TB检测,分析两组患者T-SPOT.TB检测结果的差异。结果: 合并糖尿病组和非糖尿病组患者外周血T-SPOT.TB检测阳性率分别为46.55%(54/116)和56.10%(184/328),差异无统计学意义(χ²=3.140,P=0.076);胸腔积液T-SPOT.TB检测阳性率分别为65.52%(76/116)和88.41%(290/328),合并糖尿病组明显低于非糖尿病组,差异有统计学意义(χ²=31.025,P<0.001)。合并糖尿病组和非糖尿病组患者胸腔积液T-SPOT.TB检测阳性率均高于外周血,差异均有统计学意义(χ²=4.845,P=0.028;χ²=12.848,P<0.001)。结论: 当结核性胸膜炎患者合并2型糖尿病时,胸腔积液T-SPOT.TB检测阳性率降低,但仍高于外周血T-SPOT.TB检测结果;建议考虑优先行胸腔积液T-SPOT.TB检测,以提高阳性检出率。