非耐药与耐多药肺结核患者外周血T淋巴细胞亚群及细胞因子的变化

目的对非耐药(DS)及耐多药(MDR)肺结核患者外周血T淋巴细胞亚群及细胞因子的变化及意义进行探讨。方法 对某医院及某结核病防治所2011年7月-2012年7月住院的肺结核患者（其中DS肺结核患者20例，MDR肺结核患者15例）以及医院同期26例健康体检者（对照组）外周血的CD3+、CD4+、CD8+T淋巴细胞亚群进行检测；同时检测外周血干扰素（IFN） γ、白细胞介素（IL） 10，对3组数据进行比较。结果DS肺结核组、MDR肺结核组及对照组CD3+、CD4+、CD8+T淋巴细胞亚群的表达率比较，差异无统计学意义（P＞0.05)；3组患者CD3+、CD4+、CD8+T淋巴细胞绝对值比较，差异有统计学意义（P＜0.01）；各组间两两比较，差异亦有统计学意义（P＜0.05),其中对照组CD3+［（1 426±485）/μL］、CD4+［（825±306）/μL］、CD8+T淋巴细胞［（516±213）/μL］绝对值最高，MDR肺结核组最低［分别为（746±358）/μL、（461±204）/μL、（213±101）/μL］。3组间IFN γ浓度比较，差异有统计学意义（P＜0.01)；各组间两两比较，差异亦有统计学意义（P＜0.05)，其中对照组浓度 ［（65.04±36.31）pg/mL］最高，MDR肺结核组 ［（23.32±14.04）pg/mL］最低。3组间IL 10浓度比较，差异无统计学意义（P＞0.05）。结论人类痰菌阳性肺结核及MDR肺结核患者外周血CD3+、CD4+、CD8+T淋巴细胞绝对值及血清IFN γ有不同程度下降，其下降可能促进了结核病情进展，且可能为耐药肺结核形成的原因之一。

Change in peripheral blood T lymphocyte subsets and cytokines in patients with drug sensitive and multidrug resistant pulmonary tuberculosis

Objective To evaluate the changes and significance of T lymphocyte subsets and cytokines in peripheral blood of patients with drug-sensitive and multidrug-resistant pulmonary tuberculosis（MDR pulmonary TB）.Methods From July 2011 to July 2012,T lymphocyte subsets（CD3＋,CD4＋,and CD8＋T）and cytokines（IFN-γand IL-10）were detected in patients with drug-sensitive pulmonary TB（DS group,20 cases）,MDR pulmonary TB（MDR group,15 cases）and healthy physical examination persons（control group,26 cases）in a hospital,data of three groups were compared.Results No significant differences were found in percentages of CD3＋,CD4＋,and CD8＋T among three groups（P0.05）;there were significant differences in absolute counts of CD3＋,CD4＋,and CD8＋T among three groups（P0.01）,and the difference between every two groups was also significant（P0.05）,which was highest in control group（CD3＋1 426±485]/μL;CD4＋825±306]/μL;CD8＋T516±213]/μL）and lowest in MDR group（CD3＋746±358]/μL;CD4＋461±204]/μL;CD8＋T213±101]/μL）.There were significant differences in IFN-γvalue among three groups（P0.01）,and the difference between every two groups was also significant（P0.05）,which was highest in control group（65.04±36.31]pg/mL）and lowest in MDR group（23.32±14.04]pg/mL）.No significant differences were found in IL-10 among three groups（P0.05）.Conclusion The absolute counts of T lymphocyte subsets CD3＋,CD4＋,and CD8＋T as well as IFN-γdeclined in drug-sensitive pulmonary TB patients and MDR pulmonary TB patients,which may accelerate the progress of TB and be one of the causes of MDR pulmonary TB.