活动性肺结核患者外周血T-SPOT．TB测定与细菌学及影像学的关系

目的探讨活动性肺结核患者外周血Y-干扰素释放分析T-SPOT．TB测定与不同痰结核菌分级及肺部病变程度的关系。方法采用T-SPOT．TB技术、根据斑点形成细胞数（SFCs）检测77例初治活动性肺结核患者、14例肺部非结核病变者和12例健康对照者外周血结核抗原特异性的IFN-Y分泌细胞数,结合痰细菌学和影像学检查进行分析。结果肺结核组T-SPOTTB的6KD早期分泌抗原靶点抗原孔（A孔）SFCs为55．00（21．00～102．50）,10KD培养滤过蛋白抗原孔（B孔）SFCs为65．D0（20．50～152．50）,显著高于非肺结核组和健康对照组（P〈0．05）。肺结核痰菌分级4＋组A孔SFCs为1700（400～31．50）,显著低于痰菌阴性组的82．50（36．25～10375）、1～9条组的65．00（28．50～102．50）、1＋组的8000（32.75～12625）、2＋组的90．OO（27．50～145．00）和3＋组的45．00（1800～150．00）（U=41．5,17．O,2215,26．5,30．5;Z=-2．745,-2．980,-3．325,-2．975,-2．377;均P〈0．05）;痰菌分级4＋组B孔SFCs为21．00（250～42．50）,显著低于痰菌阴性组的85．00（9．00～195．00）、1～9条组的102．50（71．25～193．75）、1＋组的92．50（33.25～165．00）、2＋组的70．00（34.00～162．50）和3＋组的6000（20．00～140．00）,（U=55．0,100。28．5,285,36．5;Z=-2．150,-3．413,-3．304,-2．874,-2．031;均P〈0．05）。A孔和B孔SFCs在不同病变范围的肺结核患者之间比较差异有统计学意义（F=7．463,3．205;P〈005）,病变范围重度组A孔SFCs为（31．95±51．09）,低于轻度组的（99．22±6909）和中度组（72．43±49．31）（t=3．520,2,845;均P〈0．05）;病变范围重度组B孔SFCs为f49．42±87．73）,低于轻度组（112．39±75．20）和中度组（104．00±9430）（,=2505,2．080;均P〈0．05）。肺结核空洞组和无空洞组比较,A孔和B孔SFCs均差异无统计学意义（P〉0．05）。结论过高的痰结核菌负荷抑制肺结核患者外周血特异性T细胞的IFN-y释放反应,抑制肺结核患者的保护性免疫;肺结核患者外周血IFN-y分泌细胞数越少,肺部病变程度的越重,但与肺结核空洞形成无关系。

Bacterial and radiographic correlates of the detection about peripheral-blood T-SPOT.TB in patients with active pulmonary tuberculo-

Objective To determine the relationship between the interferon-y release assays measured by T-SPOT.TB in peripherat blood and mycobacterium tuberculosis smear grading and radiographic extent of disease in patients with active pulmonary tuberculosis. Methods T-SPOT.TB assay was used to determine spot-forming cells （SFCs） formed by T-cell which release interferon-y when stimulated by Mycobaeterium tuberculosis-specific antigens in 77 patients with active tuberculosis, 14 case controls with non-tuberculosis lung diseases and 12 healthy controls, then the SFCs were compaired with bacteriological and radiographic presentations in new cases of pulmonary tuberculosis. Results The SFCs of A hole in response to ESAT-6 and B hole in response to CFP-10 in pulmonary tuberculosis group were 55.00（21.00-102.50） and 65.00（20.50-152.50）, respec- tively,which were all significantly higher than those in controls （P〈0.05）. The SFCs of A hole and B hole in pulmonary tuberculosis patients with mycobacterium tuberculosis grade of 4＋ were 17.00（4.00-31.50）and 21.00（2.50-42.50）, respectively. The SFCs of A hole in pulmonary tuberculosis patients with mycobacterium tuberculosis grade of negative, 1-9institias, 1＋, 2＋ and 3＋ were 82.50（36.25-103.75）,65.00（28.50-102.50）,80（32.75-126.25）,90.00（27.50-145.00） and 45.00（18.00-150.00）, and the SFCs of B hole were 85.00 （9.00-195.00）,102.50 （71.25-193.75）,92.50（33.25-165.00）, 70.00（34.00-162.50） and 60.00（20.00-140.00）, re- spectively. The SFCs of A hole in pulmonary tuberculosis patients with mycobacterium tuberculosis grade of 4＋ were significantlyhigher than thoses in patients with grade of negative, 1-9 institias, 1＋, 2＋ and 3＋ （U=41.5, 17.0, 22.5, 26.5, 30.5;Z=-2.745, -2. 980, -3.325, -2.975, -2.377; P〈0.05）, so as the SFCs of B hole （U=55.0, 10.0, 28.5, 28.5, 36.5;Z=-2.150, -3.413, -3.304, -2. 874, -2.031; P〈0.05）. There were statistical significance about the SFCs of A hole and B hole compared with different extent of disease （F=7.463,3.205;P〈0.05）. The SFCs of A hole in patients with advance disease, minimal disease and moderate disease were （31.95 ± 51.09）, （99.22 ±69.09） and （72.43± 49.31）, and the SFCs of B hole were （49.42± 87.73）, （112.39 ±75.20） and （104.00 ±94.30）, respectively. The SFCs of A hole in patients with advance disease were significantly lower than minimal disease and moderate disease （t=3.520, 2.845; P〈0.05）, so as the SFCs of B hole（Z=2.505, 2.080; P〈0.05）. There were no statistical sig- nificance about the SFCs of A hole and B hole compared with cavity and no cavity. Conclusion Exorbitant bacterial burden of mycobacterium tuberculosis depressed the interferon- y release assays formed by tuberculosis-specific T-cell in patient,s pe- ripheral blood,so that may inhibit protective immunity in patients with pulmonary tuberculosis. SFCs formed by T-cell which re- lease interferon- y in patient,s peripheral blood were decreased with the severity of the extent of disease and found to be lower in advance disease, but had no relationship with cavity of pulmonary tuberculosis.