T、B淋巴细胞及免疫球蛋白和补体在尘肺病患者外周血中的变化及其相关性分析

目的 分析尘肺病患者外周血中T、B淋巴细胞的表达和免疫球蛋白及补体的水平及其相关性.方法 选取苏州市第五人民医院住院尘肺病患者103例为研究对象,56例健康体检者为正常对照.采用流式细胞术测定患者和对照者外周血T、B淋巴细胞亚群数量;采用免疫透射比浊法测定患者外周血血清中IgG、IgM、IgA、C3、C4.结果 ①尘肺组患者外周血T细胞亚群(CD3+、CD4+、CD8+)百分比均低于正常对照组(P值均＜0.05),其中Ⅰ期、Ⅱ期、Ⅲ期尘肺病患者外周血中T细胞亚群(CD3+、CD4+T淋巴细胞百分比)的表达,与正常对照组比较差异均有统计学意义(t=2.78、2.80、3.12和t=2.24、3.02、3.17,P值均＜0.05),Ⅰ期尘肺组CD8+T淋巴细胞与正常对照组比较差异有统计学意义(t =2.44,P＜0.05),各期间差异无统计学意义(P＞0.05).②尘肺组患者外周血B淋巴细胞(CD3-CD19+)百分比高于正常对照组,差异有统计学意义(t=-5.150,P＜0.05),其中Ⅰ期、Ⅱ期、Ⅲ期CD3-CD19+百分比均高于正常对照组,差异有统计学意义(t=-4.20、-2.60、-4.25,P值均＜0.05),各期间差异无统计学意义(P＞0.05).③尘肺组患者免疫球蛋白IgG、IgM均高于正常对照组,差异有统计学意义(t=-2.441、-2.417,P值均＜0.05),分组中尘肺I瑚、尘肺Ⅲ期IgM与正常对照组比较差异有统计学意义(t=-2.79、-3.03,P值均＜0.05).④尘肺组补体C3低于正常对照组(t=2.08,P＜0.05),其中Ⅰ期补体C3低于正常对照组(t =3.255,P＜0.05),Ⅱ期补体C3高于Ⅰ期患者,差异有统计学意义(t=-2.412,P＜0.05),Ⅲ期略有下降;尘肺组补体C4与正常对照组C4差异无统计学意义(t=0.29,P＞0.05),但其中Ⅱ期患者补体C4高于正常对照组和尘肺Ⅰ期、Ⅲ期组,差异均有统计学意义(t=-2.631、-3.234、-2.228,P值均＜0.05).⑤尘肺病患者外周血免疫球蛋白IgG与IgA呈正相关(r=0.593,P＜0.000 1);补体C3与C4呈正相关(r=0.609,P＜0.000 1).结论 尘肺病患者免疫功能紊乱,体液免疫功能亢进,T、B淋巴细胞和免疫球蛋白及补体水平变化的分析对尘肺病临床诊断、分期、预后判断以及发病机制的探讨有一定意义.

Changes and correlation of T cell,B cell,immunoglobulin and complement in peripheral blood of patients with pneumoconiosis

Objective Analyze the expressions of T and B lymphocytes,immunoglobulin and complements in peripheral blood of pneumoconiosis patients.Methods One hundred and three pneumoconiosis patients were selected from Suzhou Fifth People's Hospital,and 56 healthy volunteers were selected as the normal controls.Flow cytometry was used to determine the number of peripheral T and B lymphocytes of patients and controls,while immune transmission turbidimetry was used to determine patients'peripheral serum IgG,IgM and IgA,C3 and C4.Results ①Percentages of peripheral T cell subsets (CD3+,CD4+,CD8+) were all lower in pneumoconiosis patients than in control group (P ＜ 0.05),among them,percentages of CD3+T and CD4+ T cells in pneumoconiosis groups at Ⅰ,Ⅱ and Ⅲ stages(t =2.78,2.80,3.12 and t =2.24,3.02,3.17 respectively,all P ＜0.05) and percentage of CD8+ T cells at stage Ⅰ had significant difference compared with the normal control group (t =2.44,P ＜0.05) but had no significant differences in the other groups (P ＞ 0.05).② Percentage of peripheral B lymphocyte (CD3-CD19+) was higher in pneumoconiosis patients than in normal control group(t =-5.150,P ＜0.05),in the Ⅰ,Ⅱ and Ⅲ stages the percentage of CD3-CD19+ B were higher than control group(t =-4.20,-2.60,-4.25 respectively,all P ＜0.05) but the other were not (P ＜0.05).(③) IgG and IgM of pneumoconiosis group were both higher than normal control group(t =-2.441 and-2.417,all P ＜0.05),and there were significant differences between pneumoconiosis stage Ⅰ and pneumoconiosis stage Ⅲ with normal control group in IgM (t =-2.79 and-3.03,all P ＜0.05).④The C3 was lower in the pneumoconiosis group (t =2.08,P ＜0.05) than in the normal control group.Compare with the normal group the C3 were significantly lower in the pneumoconiosis with stage Ⅰ (t =3.255,P ＜0.05).The C3 was higher at stage Ⅱ than stage Ⅰ (t =-2.412,P ＜0.05) and in the stage Ⅲ the C3 was slightly decreased;there were no significant differences betwi pneumoconiosis group and normal control group in complement C4(t =0.29,P ＞0.05),the C4 at st Ⅱ was higher than that in the control group,stage Ⅰ and Ⅲ,which were of significant differences (t =-2.631,-3.234 and-2.228 respectively,all P ＜0.05).⑤The relationship between IgG and IgA in pneumoconiosis patients were positive correlation (r =0.593,P ＜0.000 1) and the C3 and C4 had the same correlation(r =0.609,P ＜0.000 1).Conclusions Patients with pneumoconiosis have immune dysfunction and humoral immune hyperfunction.Analysis the changes of T and B lymphocytes,immunoglobulin and complement levels have significance in clinical diagnosis,staging,and prognosis and pathogenesis research of pneumoconiosis.