肺结核并低蛋白血症对细胞免疫功能的影响

目的进一步提高肺结核并低蛋白血症的治疗有效率,探讨其对细胞免疫功能状况影响。方法选取26例初治肺结核并低蛋白血症患者（低蛋白组）,其中男性23例,女性3例;选取同期住院治疗的初治肺结核并血清蛋白正常者31例（对照组）,其中男性21例,女性10例,观察治疗前细胞免疫功能状况。结果 （1）低蛋白组肺结核患者治疗前血清白蛋白与PPD皮试检查结果呈正相关（r=0.425,P=0.001）;PPD皮试〈10 mm的患者在低蛋白组较对照组多,差异有统计学意义（χ2=5.926 7,P〈0.05）。（2）低蛋白组患者的CD3＋、CD4＋及CD8＋T淋巴细胞计数异常者分别占80.8%,53.9%和69.2%。肺结核患者治疗前血清白蛋白与CD4＋T淋巴细胞计数呈正相关（r=0.288,P=0.030）;低蛋白组治疗前除CD4＋T淋巴细胞患者异常者较对照组多,差异有统计学意义（P〈0.05）外,其他与对照组比较,差异无统计学意义。（3）低蛋白组的CD4＋T淋巴细胞异常者以老年患者居多（9/12,75.0%）,与对照组（5/14,35.7%）相比其优势比为2.1;其次,PPD皮试〈10 mm较多（12/20,60.0%）,与对照组（1/6,16.7%）相比其优势比为3.6。结论细胞免疫功能低下的肺结核患者,当合并低蛋白血症时,其细胞免疫功能低下更明显,治疗肺结核并低蛋白血症患者时,要充分考虑其影响。

Cellular immune function in tuberculosis patients with hypoproteinemia

Objective To explore the cellular immune function of patients with tuberculosis and hypoproteinemia,and to improve the cure rate of the patients.Methods Twenty-six patients with newly diagnosed tuberculosis and hypoproteinemia（23 males and 3 females）were divided into hypoproteinemia group,and 31 newly diagnosed tuberculosis patients with normal serum protein（21 males and 10 females）control group.Cellular immune function of the patients were evaluated.Results（1） Concentration of serum albumin was positively associated with PPD skin test diameter in patients of hypoproteinemia group（r=0.425,P=0.001）.More patients with PPD skin test diameter10 mm were found in hypoproteinemia group compared with those in control group（χ2=5.926 7,P0.05）.（2）There were 80.8%,53.9% and 69.2% of the patients with abnormal CD3＋,CD4＋ and CD8＋ respectively in hypoproteinemia group.Concentration of serum albumin was positively associated with CD4＋ T-lymphocyte count in tuberculosis patients before treatment（r=0.288,P=0.030）;More patients with abnormal CD4＋ T-lymphocyte counts were found in hypoproteinemia group than those in control group（P0.05）.（3）Compared with those in control group（5/14,35.7% and 1/6,16.7%）,more elderly patients with abnormal CD4＋ T-lymphocyte counts（9/12,75.0%）and more patients with PPD skin test diameter10 mm（12/20,60.0%）were found in hypoproteinemia group.Conclusion Impaired cellular immune function is investigated in tuberculosis patients with hypoproteinemia,which should be noticed in clinical treatment.