活动性肺结核患者外周血T-SPOT.TB测定与细菌学及影像学的关系

摘要

Objective To determine the relationship between the interferon- γ release assays measured by T- SPOT.TB in peripheral blood and mycobacterium tuberculosis smear grading and radiographic extent of disease in patients with active pulmonary tuberculosis. Methods T- SPOT.TB assay was used to determine spot- forming cells (SFCs) formed by T- cellwhich release interferon- γ when stimulated by Mycobacterium tuberculosis- specific antigens in 77 patients with active tuberculosis, 14 case controls with non- tuberculosis lung diseases and 12 healthy controls, then the SFCs were compaired with bacteriological and radiographic presentations in new cases of pulmonary tuberculosis. Results The SFCs of A hole in response to ESAT- 6 and B hole in response to CFP- 10 in pulmonary tuberculosis group were 55.00 (21.00- 102.50)and 65.00(20.50- 152.50),re-spectively,which were al significantly higher than those in controls (P<0.05). The SFCs of A hole and B hole in pulmonary tuber-culosis patients with mycobacterium tuberculosis grade of 4+were 17.00(4.00- 31.50)and 21.00(2.50- 42.50), respectively. The SFCs of A hole in pulmonary tuberculosis patients with mycobacterium tuberculosis grade of negative,1- 9institias, 1+, 2+ and 3+ were 82.50 (36.25- 103.75),65.00 (28.50- 102.50)、80(32.75- 126.25),90.00(27.50- 145.00)and 45.00(18.00- 150.00),and the SFCs of B hole were 85.00 (9.00- 195.00),102.50 (71.25- 193.75),92.50 (33.25- 165.00), 70.00 (34.00- 162.50)and 60.00 (20.00- 140.00),respectively. The SFCs of A hole in pulmonary tuberculosis patients with mycobacterium tuberculosis grade of 4+ were significantly higher than thoses in patients with grade of negative,1- 9 institias, 1+, 2+ and 3+(U=41. 5,17.0,22.5,26.5,30.5;Z=- 2.745,- 2.980,- 3.325,- 2.975,- 2.377;P<0.05), so as the SFCs of B hole(U=55.0,10.0,28.5,28.5, 36.5;Z=- 2.150,- 3.413,- 3.304,- 2.874,- 2.031;P<0.05). There were statistical significance about the SFCs of A hole and B hole compared with different extent of disease(F=7.463,3.205;P<0.05). The SFCs of A hole in patients with advance disease, minimal disease and moderate disease were (31.95±51.09),(99.22±69.09)and(72.43±49.31), and the SFCs of B hole were(49.42± 87.73),(112.39±75.20)and(104.00±94.30),respectively.The SFCs of A hole in patients with advance disease were significantly lower than minimal disease and moderate disease (t=3.520,2.845;P<0.05), so as the SFCs of B hole(t=2.505,2.080;P<0.05). There were no statistical significance about the SFCs of A hole and B hole compared with cavity and no cavity. Conclusion Ex-orbitant bacterial burden of mycobacterium tuberculosis depressed the interferon- γ release assays formed by tuberculo-sis- specific T- cellin patient,s peripheral blood,so that may inhibit protective immunity in patients with pulmonary tuberculosis. SFCs formed by T- cellwhich release interferon- γin patient,s peripheral blood were decreased with the severity of the extent of disease and found to be lower in advance disease,but had no relationship with cavity of pulmonary tuberculosis.%目的：探讨活动性肺结核患者外周血γ-干扰素释放分析T- SPOT.TB测定与不同痰结核菌分级及肺部病变程度的关系。方法采用T- SPOT.TB技术、根据斑点形成细胞数（SFCs）检测77例初治活动性肺结核患者、14例肺部非结核病变者和12例健康对照者外周血结核抗原特异性的IFN-γ分泌细胞数，结合痰细菌学和影像学检查进行分析。结果肺结核组T- SPOT. TB 的6KD早期分泌抗原靶点抗原孔（A孔）SFCs为55.00（21.00~102.50），10KD培养滤过蛋白抗原孔（B孔）SFCs为65.00（20.50~152.50），显著高于非肺结核组和健康对照组（P＜0.05）。肺结核痰菌分级4+组A孔SFCs为17.00(4.00~31.50)，显著低于痰菌阴性组的82.50（36.25~103.75）、1~9条组的65.00（28.50~102.50）、1+组的80.00（32.75~126.25）、2+组的90.00（27.50~145.00）和3+组的45.00（18.00~150.00），（U=41.5，17.0，22.5，26.5，30.5；Z=-2.745，-2.980，-3.325，-2.975，-2.377；均P＜0.05）；痰菌分级4+组B孔SFCs为21.00（2.50~42.50），显著低于痰菌阴性组的85.00（9.00~195.00）、1~9条组的102.50（71.25~193.75）、1+组的92.50（33.25~165.00）、2+组的70.00（34.00~162.50）和3+组的60.00（20.00~140.00），（U=55.0，10.0，28.5，28.5，36.5；Z=-2.150，-3.413，-3.304，-2.874，-2.031；均P＜0.05）。A孔和B孔SFCs在不同病变范围的肺结核患者之间比较差异有统计学意义（F=7.463，3.205；P＜0.05），病变范围重度组A孔SFCs为（31.95±51.09），低于轻度组的（99.22±69.09）和中度组（72.43±49.31），（t=3.520，2.845；均P＜0.05）；病变范围重度组B孔SFCs为（49.42±87.73），低于轻度组（112.39±75.20）和中度组（104.00±94.30），（t=2.505，2.080；均P＜0.05）。肺结核空洞组和无空洞组比较，A孔和B孔SFCs均差异无统计学意义（P＞0.05）。结论过高的痰结核菌负荷抑制肺结核患者外周血特异性T细胞的IFN-γ释放反应，抑制肺结核患者的保护性免疫；肺结核患者外周血IFN-γ分泌细胞数越少，肺部病变程度的越重，但与肺结核空洞形成无关系。