初治骨关节结核患者外周血T细胞亚群特点及临床意义

目的 探讨初治骨关节结核患者外周血T细胞亚群特点、与临床观测指标的关系及抗结核治疗对患者细胞免疫状况的影响。方法 采用单平台流式细胞术检测骨关节结核患者治疗前和治疗后1-2个月T细胞亚群的绝对数及百分比，并与恶性骨肿瘤患者和健康人比较。结果 初治骨关节结核组CD4及CD8T细胞绝对数较健康对照组低（P〈0．01）。骨关节结核患者在治疗1-2个月后CD4T细胞百分比升高（P〈0．05）。青年组CD8T细胞绝对数和百分比显著高于中年组和老年组（P〈0．05，P〈0．01），CD4／CD8显著低于中年组及老年组（P〈0.01）。T细胞亚群各参数与PPD反应直径、红细胞沉降率和C反应蛋白之间无显著相关性（P〉0．05）。脊柱结核合并脓肿组CD4／CD8较低，CD8T细胞百分比较高（P〈0．01）。结论 初治骨关节结核患者存在细胞免疫缺陷，以中老年组更明显。脊柱结核是否形成脓肿与CD8T细胞有关。初治骨关节结核患者经1～2个月化疗后，细胞免疫状况改善，是病灶清除术的有利时机．

The characters and clinical significance of T lymphocyte subsets in peripheral blood of new patients with osteoarticular tuberculosis

Objective To investigate the features,changes of T lymphocyte subsets in peripheral blood of new patients with osteoarticular tuberculosis pre-and post antituberculosis treatment and to investigate their correlations to clinical factors.Methods The absolute counts and percentages of lymphocyte subsets in pre-treatment and 1 month post-treatment cases with osteoarticular tuberculosis were detected by single-platform flow cytometry.T lymphocyte subsets in osteoarticular tuberculosis patients were compared with those in patients with malignant primary or metastatic bone tumor and normal controls.Results The absolute counts of CD4 and CD8 T lymphocyte in osteoarticular tuberculosis patients were significantly lower than those in normal controls and malignant bone tumor patients(P< 0.01).The percentages of CD4 T lymphocytes were significantly higher in 1-2 months post-treatment patients than those in pre-treatment patients(P< 0.05).The levels of absolute counts and percentage of CD8 T lymphocytes in adolescent patients were significantly higher than those in middle-aged and elderly patients(P< 0.05,P< 0.01).The levels of CD4/CD8 ratio in adolescent patients were significantly lower than those in middle-aged and elderly patients(P< 0.01).No significant correlations were found between T lymphocyte subsets values and diameter of induration of PPD test,ESR or CRP in new cases with osteoarticular tuberculosis(P >0.05).The percentages of CD8 T lymphocytes and the CD4/CD8 ratio in spinal tuberculosis patients with abscesses were significantly higher than those without abscesses(P< 0.01).Conclusion The cell-mediated immunity in new patients with osteoarticular tuberculosis,especially in middle-aged and elderly patients,is lower than that in normal controls.The appearance of abscesses in spinal tuberculosis patients is correlated to CD8 T lymphocyte.The cell-mediated immunity in osteoarticular tuberculosis patients after 1-2 months therapy presents an ascending tendency when debridement operation is performed.