肺结核患者的Th1/Th2细胞因子失衡

目的　探讨肺结核患者是否存在Th1/Th2反应失衡 ,以及与病情严重程度和治疗反应的关系。方法　对 10 0名健康对照和 12 4例未经治疗的菌阳肺结核患者检测血清IgE、IL 4和IFN γ ,比较两组间差异并分析其与病情严重程度、治疗后痰菌阴转情况及初复治的关系。结果　肺结核组血清IgE(1.0 4 8± 0 .4 96 )、IL 4 (0 .4 39± 0 .16 0 )显著高于健康对照组 (分别为 0 .86 7± 0 .2 89和 0 .4 2 1±0 0 2 4 ) ,而血清IFN γ(0 .2 13± 0 .0 17)显著低于健康对照组 (0 .2 2 4± 0 .0 0 5 )。病灶范围大或有空洞形成的患者血清IL 4显著高于病灶范围小的患者 ,复治患者IL 4和IFN γ显著低于初治患者。抗结核治疗 2个月后痰菌未转阴组与痰菌阴转组相比 ,前者治疗前血清IL 4较高而IFN γ较低。结论　未经治疗的肺结核患者存在Th1反应减弱 ,Th2反应增强 ,其中病灶范围大或有空洞形成的患者更为显著。而且Th1反应较弱者治疗效果较差。

Imbalance of Th1/Th2 cytokines in patients with pulmonary tuberculosis

OBJECTIVE: To explore if there is an imbalance of Th1/Th2 cytokines in patients with pulmonary tuberculosis and its correlation with disease severity and treatment results. METHODS: The levels of serum IgE, IL-4 and IFN-gamma were measured in 100 healthy controls and 124 patients with pulmonary tuberculosis who were sputum positive for Mycobacterium tuberculosis before treatment. The cytokine levels were compared and their correlation with disease severity, sputum conversion after treatment, and treatment protocols were analyzed. RESULTS: The serum levels of IgE, IL-4 and IFN-gamma were 1.048 +/- 0.496, 0.439 +/- 0.160 and 0.213 +/- 0.017 respectively in pulmonary tuberculosis, and 0.867 +/- 0.289, 0.421 +/- 0.024 and 0.224 +/- 0.005 respectively in the controls. The serum level of IL-4 was higher in patients with severe disease than that in patients with milder disease. Both IL-4 and IFN-gamma were significantly higher in cases receiving a second course of therapy than in patients receiving initial therapy. In patients who were sputum positive for Mycobacterium tuberculosis after two months of therapy, the serum level of IL-4 was higher but that of IFN-gamma was lower compared to those who became sputum negative for Mycobacterium tuberculosis after two months' treatment. CONCLUSIONS: Patients with active pulmonary tuberculosis before antituberculous therapy showed lower expression of Th1 and higher expression of Th2 cytokines, and this cytokine profile was correlated with disease severity. Patients with lower serum IFN-gamma and higher IL-4 before treatment were less responsive to antituberculous therapy.