肺结核患者病情严重程度与免疫功能受损程度的相关性研究

摘要

Objective To explore the correlation between severity of pulmonary tuberculosis and impairment of immunity function. Methods A total of 76 patients with pulmonary tuberculosis, who were enrolled into Department of Infectious Diseases in our hospital during February 2012 to January 2014, were selected as study subjects. According to clinical manifestation, referring to imaging and drug sensitivity, all of these patients were divided into untreated group (29 cases), retreatment group (23 cases) and refractory group (24 cases). In the same period, 42 cases of healthy people in our hospital for physical examination were selected as the control group. The flow cytometry was used to detect the peripheral blood T cell subsets ratio (CD3+, CD4+, CD8+and CD4+/CD8+) and NK cells, and the correlation between se-verity of pulmonary tuberculosis and impairment of immunity function was analyzed. Results The gender, age and body mass index of three patient groups have no significant differences (P>0.05). T lymphocyte subsets (CD3+, CD4+ and CD4+/CD8+) and natural killer cells (NK cells) of the control group [(68.39 ± 5.12)%, (42.15 ± 9.37)%, (1.64 ± 0.24), (17.64 ± 3.56)%, respectively] were significantly higher than those of pulmonary tuberculosis group [(55.22±9.37)%, (33.26±8.67)%, (1.38±0.26), (14.36±4.51)%, respectively] (P<0.01). T lymphocyte subsets (CD8+) of pulmonary tuberculosis group (27.34 ± 4.59)%was significantly higher than that of the control group (24.39+4.25)%(P<0.01). There were significant differences among three pulmonary tuberculosis groups in terms of T lymphocyte subsets and NK cells (P<0.01). LSD showed initial treatment group>retreatment group and refractory group for T lymphocyte subsets (CD4+, CD4+/CD8+) and NK cells; initial treatment group>retreatment group>refractory group for T lymphocyte subsets (CD3+);retreatment group and refractory group>initial treatment group for T lymphocyte subsets (CD8+). Conclusion There are significant differences between severity of pulmonary tuberculosis and impair-ment of immunity function, and the level of T lymphocytes and NK cells has a corresponding predictive value for the se-verity of pulmonary tuberculosis.%目的 探究肺结核患者不同病情与免疫功能受损程度的相关性.方法 选取2012年2月至2014年1月在我院传染病科住院治疗的肺结核患者76例,根据患者临床表现,参照影像学及药物敏感性测定,将患者分为初治组29例,复治组23例,难治组24例,同时选取在同一时期来我院体检的健康人42例作为对照组,采用流式细胞仪检测所有受检者的外周血T细胞亚群(CD3+、CD4+、CD8+比率及CD4+/CD8+)比例及NK细胞,分析肺结核患者不同严重程度与细胞免疫功能受损程度的相关性.结果 三组肺结核患者间在性别、年龄及体质指数(BMI)方面比较差异均无统计学意义(P>0.05);在T淋巴细胞亚群(CD3+、CD4+及CD4+/CD8+)和自然杀伤细胞(NK细胞)方面,对照组分别为(68.39±5.12)%、(42.15±9.37)%、(1.64±0.24)、(17.64±3.56)%,显著高于结核组的(55.22±9.37)%、(33.26±8.67)%、(1.38±0.26)、(14.36±4.51)%,(P<0.01),在T淋巴细胞亚群(CD8+)上,结核组为(27.34±4.59)%,显著高于对照组的(24.39±4.25)%,差异有统计学意义(P<0.01);不同严重程度肺结核患者间T淋巴细胞亚群及NK细胞上差异有显著统计学意义(P<0.01).经LSD检测,在T淋巴细胞亚群(CD4+、CD4+/CD8+)及NK细胞上,初治组>复治组和难治组,在T淋巴细胞亚群(CD3+)上,初治组>复治组>难治组,在T淋巴细胞亚群(CD8+)上,复治组、难治组>初治组.结论 肺结核患者不同病情严重程度间免疫功能受损程度存在差异,T淋巴细胞及NK细胞的水平变化对肺结核病情严重程度起到相应预测价值.