HIV抗体阴性结核性脑膜炎患者治疗前后外周血CD细胞水平的变化情况

目的: 分析HIV抗体阴性结核性脑膜炎(tuberculous meningitis,TBM)患者抗结核治疗前后外周血CD细胞水平的变化及临床意义。方法: 采用前瞻性研究的方法,选取2016年3月至2020年2月于新疆医科大学第八附属医院就诊且符合入组标准的102例TBM患者作为研究对象,其中,临床分期Ⅰ期22例、Ⅱ期37例、Ⅲ期43例。于研究对象抗结核治疗前及治疗2周后,检测其外周血CD3⁺、CD4⁺、CD8⁺T细胞计数及CD4⁺/CD8⁺T细胞比值。分析研究对象治疗前后外周血CD细胞水平变化情况,及其与TBM临床分期和患者治疗转归的相关性。结果: 抗结核治疗2周后,研究对象CD3⁺、CD4⁺ T细胞计数和CD4⁺/CD8⁺ T细胞比值[分别为(808.27±183.25)×10⁶个/μl、(413.09±134.53)×10⁶个/μl和1.23±0.29]均明显高于治疗前[分别为(631.38±150.14)×10⁶个/μl、(366.78±98.03)×10⁶个/μl和0.99±0.23],差异均有统计学意义(t=7.541,P=0.000;t=2.809,P=0.005;t=6.548,P=0.000)。抗结核治疗2周后,Ⅲ期TBM患者的CD3⁺、CD4⁺T细胞计数与CD4⁺/CD8⁺T细胞比值[分别为(613.23±140.29)×10⁶个/μl、(342.53±98.36)×10⁶个/μl、0.95±0.18]明显低于Ⅱ期患者[分别为(753.33±153.47)×10⁶个/μl、(399.57±112.26)×10⁶个/μl、1.22±0.21]和Ⅰ期患者[分别为(989.23±194.35)×10⁶个/μl、(501.11±139.25)×10⁶个/μl、1.42±0.31],差异均有统计学意义(F值分别为40.875、13.372、32.151,P值均为0.000)。抗结核治疗2周后,病情好转患者的CD3⁺、CD4⁺ T细胞计数与CD4⁺/CD8⁺T细胞比值[分别为(941.25±204.17)×10⁶个/μl、(487.35±134.25)×10⁶个/μl、1.36±0.31]明显高于病情恶化者[分别为(683.43±155.76)×10⁶个/μl、(389.64±120.38)×10⁶个/μl、1.02±0.19],差异均有统计学意义(t=4.206,P=0.000;t=2.394,P=0.018;t=3.698,P=0.000)。结论: TBM患者抗结核治疗2周后,免疫功能明显改善,且病情好转患者免疫功能改善程度好于病情恶化者。TBM患者临床分期越高,免疫功能受损越严重,对调整治疗方案的需求越高。

Changes of CD cells in peripheral blood of tuberculous meningitis patients with negative HIV antibody before and after treatment

Objective:To analyze the changes and clinical significance of CD cells in peripheral blood of tuberculous meningitis(TBM)patients with negative HIV antibody before and after treatment.Methods:A prospective study was conducted in 102 TBM patients diagnosed in the Eighth Affiliated Hospital of Xinjiang Medical University from March 2016 to February 2020.All the cases met the inclusion criteria and were divided them into 3 clinical phases,22 in phaseⅠ,37 in phaseⅡ,and 43 in phaseⅢ.The counts of CD3⁺,CD4⁺and CD8⁺T cells,and the ratio of CD4⁺/CD8⁺T cells in peripheral blood of these cases were measured before and 2 weeks after anti-tuberculosis treatment.The changes of CD cells in peripheral blood before and after treatment,and their correlation with TBM clinical stages and therapeutic prognosis were analyzed.Results:Of these cases,the CD3⁺,CD4⁺T cell counts and CD4⁺/CD8⁺2 weeks after anti-tuberculosis treatment were significantly higher than those before treatment((808.27±183.25)×10⁶/μl vs.(631.38±150.14)×10⁶/μl,t=7.541,P=0.000;(413.09±134.53)×10⁶/μl vs.(366.78±98.03)×10⁶/μl,t=2.809,P=0.005;and 1.23±0.29 vs.0.99±0.23,t=6.548,P=0.000;respectively).Two weeks after anti-tuberculosis treatment,the CD3⁺,CD4⁺T cell counts and CD4⁺/CD8⁺of patients in stageⅢ((613.23±140.29)×10⁶/μl,(342.53±98.36)×10⁶/μl and 0.95±0.18,respectively)were significantly lower than those in stageⅡ((753.33±153.47)×10⁶/μl,(399.57±112.26)×10⁶/μl and 1.22±0.21,respectively)and stageⅠ((989.23±194.35)×10⁶/μl,(501.11±139.25)×10⁶/μl and 1.42±0.31,respectively)(F=40.875,13.372 and 32.151,respectively;all P=0.000).The CD3⁺,CD4⁺T cell counts and CD4⁺/CD8⁺of improved patients were significantly higher than those of patients with progressive forms of the disease((941.25±204.17)×10⁶/μl vs.(683.43±155.76)×10⁶/μl,t=4.206,P=0.000;(487.35±134.25)×10⁶/μl vs.(389.64±120.38)×10⁶/μl,t=2.394,P=0.018;1.36±0.31 vs.1.02±0.19,t=3.698,P=0.000;respectively).Conclusion:Two weeks after anti-tuberculosis treatment,the immune function of TBM patients was significantly improved,and the improvement of immune function in improved patients was better than those with worse condition.For TBM patients,the higher the clinical stage,the more severe the impairment of immune function,and the higher the need to adjust the therapeutic regimen.