活动性肺结核免疫耗竭及免疫治疗的研究进展

目的　利用ROC曲线评价CO2结合力（carbondioxide combining power, CO2-CP）对肝硬化食管胃静脉曲张破裂出血失血性休克患者预后的判断价值。方法　收集2018年6月—2019年6月我中心重症医学科收治的107例肝硬化食管胃静脉曲张出血休克患者的临床资料，根据临床转归将其分为生存组和死亡组，评估生存组和死亡组CO2-CP和碱剩余（base excess, BE）的水平，应用Spearman法对CO2-CP和BE进行相关性分析，应用AUC评估CO2-CP和BE对预后的判断价值。结果　生存组BE的平均水平为（-1.41±6.00）mmol/L，死亡组BE的平均水平为（-15.93±4.44）mmol/L，2组相比差异有统计学意义（t=8.570，P=0.000）。生存组CO2-CP的平均水平为（20.36±4.35）mmol/L，死亡组CO2-CP的平均水平为（10.07±2.49） mmol/L，2组相比差异有统计学意义（t=8.607，P=0.000）。CO2-CP和BE呈正相关（r=0.875，P=0.000）。CO2-CP和BE针对预后的AUC分别为0.871，0.922，95%CI分别为0.770～0.972，0.846～0.998，差异均无统计学意义（P均＞0.05）。结论　CO2-CP可较好地反映肝硬化食管胃静脉曲张破裂出血失血性休克患者代谢性酸中毒水平和预后预测。

and immunotherapy of active pulmonary tuberculosis

Immune exhaustion is a state of immune dysfunction commonly existing in chronic infection and tumor. Long-term and continuous stimulation of immune cells by antigens such as bacteria, viruses and tumor cells can cause immune exhaustion. Of course, Mycobacterium tuberculosis, as a special bacterium, is not exceptional. Immune exhaustion has been frequently studied in the field of tumor and virus, but scarcely studied in Mycobacterium tuberculosis infection. Immune cells in an exhaustion state cannot produce an effective immune response to Mycobacterium tuberculosis, which is accordingly unfavourable for the disease condition of tuberculosis patients. Thymosin therapy, cytokine therapy and adoptive immune cell therapy can improve the immune function of patients with active pulmonary tuberculosis, so as to assist in the treatment of immune exhaustion. This paper reviews the research progress of immune exhaustion and immunotherapy of active pulmonary tuberculosis.