肺结核合并肺癌患者免疫炎性反应及凝血指标分析

摘要

目的 探讨肺结核合并肺癌患者机体免疫炎性反应与凝血指标特点,为进一步治疗提供依据.方法 选择2012年5月至2015年10月诊断肺结核合并肺癌患者65例,依据NCCN肺癌临床肿瘤分期,分为Ⅰ～Ⅱ组与Ⅲ～Ⅳ组.并取同期单纯性肺结核患者60例为对照组.采用流失细胞仪检测患者外周血CD3+、CD4+、CD8、Th1、Th2、Th17、Treg(CD4+ CD25+~)细胞比例,计算CD4+/CD8+、Th1/Th2、Th17/Treg比值.采用酶联免疫吸附法检测血清白介素-2(IL-2)、白介素-10(IL-10)、白介素-17(IL-17)、转化生长因子-β(TGF-β)水平变化.免疫比浊法检测血浆D-二聚体水平,入组患者均给予肺动脉CTA造影检查,比较3组患者症状性肺动脉栓塞症、肺段、亚肺段肺动脉血栓形成发生率.结果 肺结核组、Ⅰ～Ⅱ期合并肺癌组与Ⅲ～Ⅳ期合并肺癌组患者外周血CD3+、CD4+T细胞比例逐渐下降,CD4+/CD8、Th1/Th2、Th17/Treg比值也呈逐渐下降变化,总组间比较差异有统计学意义(F=2.687 ～3.905,P＜0.05).其中,肺结核组、Ⅰ～Ⅱ期合并肺癌组中外周血CD3+、CD4+T细胞、CD4+/CD8+比例差异无统计学意义(t=0.871 ～0.884,P＞0.05),但Th1/Th2、Th17/Treg比值下降,差异有统计学意义(t=2.764 ～2.998,P＜0.05).肺结核组、Ⅰ～Ⅱ期合并肺癌组与Ⅲ～Ⅳ期合并肺癌组患者血清IL-2、IL-17水平逐渐下降,IL-10、TGF-β水平逐渐升高,总组间以及两两组间比较差异有统计学意义(F =2.895 ～3.098,P＜0.05).Ⅲ～Ⅳ期合并肺癌组患者D-二聚体阳性率、症状性肺动脉栓塞症发生率显著高于肺结核组、Ⅰ～Ⅱ合并肺癌组(x2=2.541 ～2.897,P＜0.05).但肺结核组与Ⅰ～Ⅱ合并肺癌组患者差异无统计学意义(X2 =0.680～0.881,P＞0.05).肺结核组、Ⅰ～Ⅱ期合并肺癌组与Ⅲ～Ⅳ期合并肺癌组患者血浆D-二聚体水平、无症状肺段、亚肺段肺动脉血栓形成发生率逐渐升高,总组间以及两两组间比较差异有统计学意义(F=3.051,x2=3.651,P＜0.05).结论 肺结核合并肺癌患者细胞免疫功能下降,免疫炎性反应调节失衡,发生肺动脉栓塞几率增加.%Objective To investigate the characteristics of immunity inflammatory responses and blood coagulation indexes in patients with pulmonary tuberculosis complicated by lung cancer in order to provide a basis for further treatment.Methods Sixty-five patients with pulmonary tuberculosis complicated by lung cancer who were dagnosed in our hospital from May 2012 and to October 2015 were enrolled in the study.According to the NCCN lung cancer clinical stages these patients were divided into two subgroups,stage Ⅰ ～ Ⅱ group and stage Ⅲ ～ Ⅳ group,at the same time,the other 60 patients with simple pulmonary tuberculosis were served as control group.The proportions of CD3+,CD4+,CD8+,Th1,Th2,Th17,and Treg (CD4+CD25+) were detected by flow cytometry to calculate the ratios of CD4+/CD8+,Th1/Th2 and Th17/Treg in peripheral blood of patients.Moreover the serum levels of interleukin-2,interleukin-10,interluken-17,and TGF-3 were measured by enzyme-linked immunoassay (ELISA),and the plasma levels of D-dimer were detected by immunoturbidimetry.In addition all the patients were examined by pulmonary artery CTA,and the incidence rates of symptomatic pulmonary embolism and arterial thrombosis ir pulmonary segment and sub-pulmonary segment were observed and compared among the three groups.Results The proportions of CD3+,CD4+,and the ratios of CD:/CD8+,Th1/Th2 and Th17/Treg were gradually decreased in order of stage Ⅰ ～ Ⅱ group,stage Ⅲ ～ Ⅳ group,control group,there were significant differences among the three groups (P ＜0.05),in which there were no significant differences in proportion of CD3+,CD:,and ratio of CD4+/CD8+ between stage Ⅰ ～ Ⅱ group and control group (P ＞ 0.05),however,the ratios of Th1/Th2,Th17/Treg were significantly decreased (P ＜0.05).The levels of IL-2,IL-17 were gradually decreased in order of stage Ⅰ ～ Ⅱ group,stage Ⅲ ～ Ⅳ group,however,the levels of IL-10,TGF-β were gradually increased,there were significant differences between two groups (P ＜ 0.05).In addition the positive rate of D-dimer and incidence rate of symptomatic pulmonary embolism in stage Ⅲ ～ Ⅳ group were significantly higher than those in the other two groups (P ＜ 0.05).However,there were no significant differences between control group and stage Ⅰ ～ Ⅱ group (P ＞ 0.05).Moreover the levels of D-dimer and incidence rates of arterial thrombosis in pulmonary segment without symptoms and sub-pulmonary segment were gradually increased in order of control group,stage Ⅰ ～ Ⅱ group,stage Ⅲ ～ Ⅳ group,there were significant differences among groups and between two groups each other (P ＜ 0.05).Conclusion The decrease of cellular immune function and disbalance are observed in patients with pulmonary tuberculosis complicated by lung cancer,with the probability of incidence of pulmonary embolism being increased.