自然杀伤T细胞在幽门螺旋杆菌阳性消化性溃疡患者中的水平与临床意义

摘要

目的：探讨幽门螺旋杆菌（Hp）阳性消化性溃疡患者（PU）外周血自然杀伤T 细胞（NKT）的表达与临床意义。方法选择83例Hp阳性PU患者（A组），以79例Hp阴性PU患者作为阳性对照（B组），以60例健康人作为阴性对照（C组）；采用流式细胞术检测A、B及C三组外周血NKT及其胞内细胞因子γ‐干扰素（IFN‐γ）及白介素4（IL‐4）水平。将A组患者随机分为D及E组，两组均给予雷贝拉唑及甲硝唑治疗，D组在此基础上给予克拉霉素治疗，E组给予阿莫西林治疗，两周后进行NKT、IFN‐γ及IL‐4的水平比较，并将3种指标与治疗前Hp感染的程度进行相关性分析。结果 B与C组间的NKT及IFN‐γ差异均无统计学意义，但A组NKT及IFN‐γ水平低于B及C组，差异有统计学意义（P＜0．05）。A组IL‐4低于B组，且B组低于C组，差异有统计学意义（P＜0．05）。治疗前D及E组间的NKT、IFN‐γ及IL‐4差异均无统计学意义（P＞0．05），治疗后D组3种指标均显著高于E组（P＜0．05）。Spearman分析显示NKT、IFN‐γ及IL‐4均与 Hp感染程度呈负相关。结论 NKT、IFN‐γ及IL‐4水平下降导致杀伤力降低可能原因为Hp感染致PU的免疫机制破坏，且感染越重三者水平越低；克拉霉素在上调NKT、IFN‐γ及IL‐4的表达效果优于阿莫西林。%Objective To study the expression and clinical significance of natural killer T cells (NKT) in peptic ulcer (PU) pa‐tients with Helicobacter pylori (Hp) infection .Methods Eighty three PU patients with Hp were selected as group A ,79 PU pa‐tients without Hp were selected as group B and 60 healthy people were selected as the group C .Using flow cytometry ,levels of pe‐ripheral blood of NKT ,intracellular cytokines gamma interferon (IFN‐γ) and interleukin 4 (IL‐4) were detected and compared be‐tween group A ,B and C .Patients in group A were randomly divided into D and E ,and the two groups were both given rabeprazole and metronidazole .In addition ,group D added clarithromycin treatment ,and group E added amoxicillin .After two weeks ,levels of NKT ,IFN‐γand IL‐4 were tested .Meanwhile ,the relationship between three indicators and Hp infection degree was analysis .Re‐sults Levels of NKT and IFN‐γ between group B and C had no statistical difference ,but the levels of NKT and IFN‐γin group A were significantly lower than that of group B and C (P<0 .05) .IL‐4 in group A was significantly lower than that of group B ,and which of group B was also significantly lower than that of group C (P<0 .05) .Levels of NKT ,IFN‐γ and IL‐4 between group E and D before treatment had no statistical difference (P>0 .05) ,while the three indicators in group D after treatment group were significantly higher than that of group E (P<0 .05) .Spearman correlation analysis showed that NKT ,IFN‐γ and IL‐4 were nega‐tively correlated with Hp infection degree .Conclusion The decrease of NKT ,IFN‐γ and IL‐4 in cells may be the immune mecha‐nism of PU patients with Hp infection ,and the lower the levels of the three indicators ,the more serious the infection .Effect of clar‐ithromycin in up‐regulation of expression of NKT ,IFN‐γand the IL‐4 is better than amoxicillin .