肺结核患者外周血免疫细胞水平与临床意义分析

目的 探讨肺结核患者外周血免疫细胞的表达水平及其临床意义。方法 回顾性分析2016年1月至2017年5月徐州市传染病医院收治的676例肺结核患者和体检中心的40例健康对照者。采用贝克曼库尔特公司FC500型流式细胞仪,以荧光微球为参照,分别检测外周血CD4⁺、CD8⁺、B和NK细胞的绝对数。结果 肺结核患者免疫细胞CD4⁺、CD8⁺、B和NK细胞数量低于健康对照者(t=6.25,5.12,5.05,4.37;P值均为0.00);痰菌阳性的肺结核患者免疫细胞CD4⁺、CD8⁺、B、NK细胞数量低于痰菌阴性的肺结核患者(t=4.07,3.70,2.75,2.71;P=0.00,0.00,0.01,0.01);老年肺结核患者免疫细胞CD4⁺、CD8⁺、B细胞数量低于年轻患者(t=4.04,2.60,5.25;P=0.00,0.01,0.00),554例初治肺结核患者经过2个月化疗后,其中510例单纯采用标准化抗结核治疗方案的患者CD4⁺、CD8⁺、B和NK细胞数量增加无统计学意义(t=1.19,1.04,0.39,1.82;P=0.23,0.30,0.70,0.07),44例合并免疫治疗的肺结核患者除NK细胞数量增加无统计学意义(t=0.80;P=0.42),CD4⁺、CD8⁺、B数量增加(t=2.15,2.17,3.12;P=0.03,0.03,0.00)。结论 肺结核患者免疫细胞的表达水平降低,痰菌阳性以及老年肺结核患者降低尤为明显,对于免疫细胞表达水平降低的肺结核患者,在化疗的基础上配合免疫治疗更有利于患者的康复。

Expression level and clinical significance of immune cells in peripheral blood of patients with pulmonary tuberculosis

We investigated the expression level and clinical significance of immune cells in peripheral blood of patients with pulmonary tuberculosis. Data from 676 patients with pulmonary tuberculosis and 40 healthy controls collected from January 2016 to May 2017 was analyzed retrospectively. The absolute number of CD4⁺, CD8⁺, B and NK cells in peripheral blood were detected with FC500 flow cytometry, fluorescent microspheres used as a reference. Results showed that the number of CD4⁺, CD8⁺, B, NK cells in patients with pulmonary tuberculosis was significantly lower than that of healthy controls (t= 6.25, 5.12, 5.05, 4.37; P=0.00 each). The number of CD4⁺, CD8⁺, B, NK cells in sputum-positive patients with pulmonary tuberculosis was significantly lower than that in sputum-negative patients (t=4.07,3.70,2.75,2.71;P=0.00,0.00,0.01,0.01).The number of CD4⁺, CD8⁺ and B cells in elderly patients with pulmonary tuberculosis was significantly lower than in young patients(t=4.04,2.60,5.25;P=0.00,0.01,0.00). After 2 months chemotherapy about 554 initial treatment pulmonary tuberculosis, the number of CD4⁺, CD8⁺, B and NK cells did not increase significantly in 510 pulmonary tuberculosis patients with standardized anti-tuberculosis simply (t=1.19,1.04,0.39,1.82;P=0.23,0.30,0.70,0.07); the number of CD4⁺,CD8⁺ T lymphocytes and B lymphocytes increased significantly in 44 pulmonary tuberculosis patients after 2 months chemotherapy combined with immunotherapy(t=2.15,2.17,3.12;P=0.03,0.03,0.00),while the number of NK cells did not increase significantly (t= 0.80; P=0.42). The expression levels of immune cells decreased in patients with pulmonary tuberculosis, especially in the sputum positive pulmonary tuberculosis patients and elderly patients, chemotherapy combined with immunotherapy were more conducive to the rehabilitation of pulmonary tuberculosis patients whose expression levels of immune cells were significantly reduced.