IFN-γELISPOT效应性T细胞在结核性脑膜炎和肺结核中的临床价值

摘要

Objective To explicit the different level of effector T cells by IFN-γ enzyme-linked immunospot assay(IFN-γ ELISPOT)of peripheral blood in patients with tuberculous meningitis(TBM) and pulmonary tuberculosis(PTB) and analyze the function of level of IFN-γ release.Method By IFN-γ ELISPOT assay of peripheral blood in patients with TBM and PTB and healthy controls,to compare with the population of effector T cells between patients with TBM and PTB . By one year follow-up,to compare the prognosis of patients with TBM and PTB in the positive and negative IFN-γ ELISPOT groups .Results By IFN-γ ELISPOT assay,positivity rates in patients with TBM and PTB were 37.1%,76.0%, respectively.IFN-γ ELISPOT-A(ESAT-6)and B(CFP-10)in patients with TMB were lower than that in patients with PTB (P<0.0001);In GOS prognosis analysis ,the groups of positive IFN-γELISPOT were better than those of negative IFN-γ ELISPOT in patients with TBM and PTB.Conclusion IFN-γin patients with TMB were lower than that in patients with PTB.TB-exposed individuals correlates with relatively lower IFN-γ expression suggesting a mechanism for the previously observed poor prognosis.Exogenous IFN-γsupplementation may benefit patients with TBM.%目的：明确结核性脑膜炎（TBM）和肺结核（PTB）患者结核分枝杆菌抗原特异性干扰素-γ酶联免疫斑点（IFN-γ ELISPOT）的数量差异，分析IFN-γ水平变化在TBM和PTB中的作用。方法通过TBM，PTB患者和健康人的外周血进行IFN-γ ELISPOT检测,比较效应性T细胞的数量差异，并通过1年随访，比较TBM和PTB患者IFN-γ ELISPOT阳性组和阴性组预后的差异。结果 TBM组IFN-γ ELISPOT阳性率为37.1%（13/35），PTB组IFN-γ ELISPOT阳性率为76.0%（19/25）。TBM组IFN-γ ELISPOTA （ESAT-6）和B（CFP-10）明显低于PTB组（P<0.05）；患者的1年随访分析表明TBM和PTB患者IFN-γELISPOT阳性组GOS预后分析好于阴性组。结论 TBM患者IFN-γ水平明显低于PTB患者，相对低的IFN-γ的表达是预后不良机制之一，外源性IFN-γ补充可能使TBM患者获益。