调节性T细胞及Th17细胞在结核性胸膜炎中的表达及其意义

目的：探讨CD4^＋CD25^＋CD127^-调节性T细胞（Treg细胞）及辅助性T细胞17（Th17细胞）在结核性胸膜炎患者外周血及胸腔积液中的表达及其临床意义。方法：收集住院初治结核性胸膜炎患者30例，另选择健康体检人员20例为正常对照组。采用流式细胞仪检测患者和对照组外周血及患者胸腔积液中CD4^＋CD25^＋CD127^-Treg细胞及Th17细胞的表达。结果：结核性胸膜炎患者外周血组中单个核细胞（Peripheral blood mononuclear cells，PBMC）的CD4^＋T细胞值明显低于健康正常外周血组；结核性胸膜炎患者外周血中外周血PBMC的CD4^＋CD25^＋T细胞值较健康正常外周血组高；结核性胸膜炎患者外周血中CD4^＋CD25^＋CD127^-Treg细胞水平较健康对照组外周血高（P〈0．05）；结核性胸膜炎患者胸腔积液中CD4^＋CD25^＋CD127^-Treg细胞水平升高；患者胸腔积液中检测到Treg细胞，与患者外周血呈正相关；患者外周血中Th17细胞的表达低于对照组（P〈0．05）；患者胸腔积液中检测到Th17细胞。结核性胸膜炎患者在规则治疗后，结核性胸膜炎患者外周血组中PB—MC的CD4^＋T细胞值逐渐增加，而CD4^＋CD25^＋T细胞和CD4^＋CD25^＋CD127^-Treg细胞逐渐降低；患者外周血中的Th17细胞表达逐渐增加；胸腔积液中Th17细胞的含量逐渐降低。结论：CD4^＋CD25^＋CD127^-Treg细胞及Th17细胞可作为判断结核性胸膜炎患者免疫功能的指标，其通过调节机体免疫力参与结核性胸膜炎的发生、发展；CD4^＋CD25^＋CD127^-Treg细胞及Th17细胞可能在结核性胸膜炎的发病中发挥作用。它们对结核性胸膜炎患者的免疫状态、指导用药、疗效观察有一定的临床意义。

THE LEVEL AND CLINICAL SIGNIFICANCE OF REGULATORY T CELL AND TH17 CELL IN PATIENTS WITH TUBERCULOUS PLEURISY

Objective： To investigate the peripheral blood and pleural fluid expression of CD4^＋CD25^＋CD127^- Treg and Th17 cell in patients With tuberculous pleurisy and explore its clinical significance. Methods：A series of 30 tuberculous pleurisy patients were detected by flow cytometry with muhicolor fluorescence technology for CD4^＋CD25^＋CD127^-regulator T cell and Th17 cell with 20 healthy persons as control group. Results：The percentage of CD4^＋ T cell in peripheral blood of tuberculous pleurisy patients was significantly lower than that of controls （ P 〈0.05）. The percentage of CD4^＋ CD25^＋ T cell in peripheral blood of tuberculous pleurisy patients was significantly higher than that of controls （ P 〈0.05）. The percentage of CD4^＋CD25^＋CD127^- T cell in peripheral blood of tuberculous pleurisy patients was significantly higher than that of controls（ P 〈0.05） and the percentage of CD4^＋CD25^＋CD127^- T cell in pleural fluid of tuberculous pleurisy patients had increase. The CD4^＋CD25^＋CD127^- T cell was positive correlation in peripheral blood and pleural fluid . The percentage of Th17 cell in peripheral blood of tuberculous pleurisy patients was significantly lower than that of controls （ P 〈0. 05）, and Th17 in pleural fluid of tuberculous pleurisy patients had increase. After treatment, the percentage of CD4^＋ T cell in peripheral blood of tuberculous pleurisy patients was higher than the percentage of before treatment. And the percentage of CD4^＋ CD25^＋ T cell and CD4^＋CD25^＋CD127^- T cell in peripheral blood of tuberculous pleurisy patients was lower than the percentage of before treatment. The percentage of Th17 in peripheral blood and pleural fluid of tuberculous pleurisy patients was higher than the percentage of before treatment. Conclusion： CD4^＋CD25^＋CD127^- regulator T cell and Th17 cell can be used as indicator of the immune function in tuberculous pleurisy patients. It is involved in the occurrence and development of tuberculous pleurisy. CD4^＋CD25^＋CD127^- regulator T cell and Th17 cell might play an important role in the pathogenesis of tuberculous pleurisy. It is of clinical significance for the observation of immune status, medication and curative effect on tuberculous pleurisy patients.