摘要
目的:通过分析T细胞的变化以及其相关细胞因子的表达情况,对疗效评估、转归给出快速的判断和依据。方法:收集耐多药肺结核患者73例,健康人群56例。将耐多药肺结核患者分为初治耐多药组43例及复治耐多药组30例。按治疗结果分为培养转阴组58例及培养未转阴组13例。检测受试者T细胞的变化以及其相关细胞因子的表达情况,分组分析变化趋势。结果:耐多药结核患者与健康对照组进行比较分析,总T细胞、CD 4+T细胞、CD 4+/CD 8+检测两组差异无统计学意义(P>0.05),CD 8+T细胞较对照组有所增高,差异有统计学意义(P<0.01)。IL-17、IFN-γ初治组较复治组含量高具有统计学意义(P<0.05),IL-2、IL-4、IL-6复治组较初治组含量高具有统计学意义(P<0.05)。培养转阴组IL-6、TNF-α、IL-17、IL-10、IFN-γ用药周期内呈现逐渐下降的趋势;IL-2呈现逐渐升高的趋势且均有统计学意义(P<0.05),各项菌逐渐恢复到正常水平,IL-4用药前后差异无统计学意义(P>0.05)。培养未转阴组用药前及用药后2个月、6个月7种细胞因子均未出现规律性变化。结论:耐多药结核患者用药前CD 8+T细胞比健康对照组有所增高,差异有统计学意义(P<0.01),说明患者体内免疫系统发生了变化。对于初治患者来讲,用药前机体会释放大量的IFN-γ,随着诊疗活动的开展体内的细菌含量逐渐减少,IFN-γ也逐渐减少。复治组,由于既往感染过结核菌,体内记忆型T细胞迅速被激活释放出大量与记忆性T细胞相关的细胞因子包括IL-2、IL-4等所以在用药前较初治组呈现升高趋势,可能与机体内的免疫防御机制也有一定关系。用药后2~6个月细胞因子的变化较用药前是相反趋势的现象,提示有可能出现治疗失败,与机体内菌量是否得到控制,机体免疫功能是否恢复具有相关性。
Objective By analyzing the changes of T cells and the expression of related cytokines,we could quickly judge the curative effect and prognosis.Method 73 patients with MDR-TB and 56 healthy people were collected.The patients were divided into initial treatment group(43 cases)and retreatment group(30 cases).According to the treatment results,Multidrug-resistant pulmonary tuberculosis(MDR-TB)patients were divided into negative culture group(58 cases)and non-negative culture group(13 cases).The change of T cells and the expression of related cytokines were detected,and the trend of change was analyzed by grouping.Results Comparing MDR-TB patients with healthy control group,there was no significant difference in total T cells,CD 4+T cells and CD 4+/CD 8+between the two groups(P>0.05),CD 8+T cells increased compared with the control group(P<0.01).The contents of IL-17 and IFN-gamma in the initial treatment group were higher than those in the retreatment group(P<0.05).The contents of IL-2,IL-4 and IL-6 in the retreatment group were higher than those in the initial treatment group(P<0.05).IL-6,TNF-alpha,IL-17,IL-10 and IFN-gamma showed a gradual downward trend in the period of drug administration in the culture negative group,while IL-2 showed a gradual upward trend with statistical significance(P<0.05),and the bacteria gradually returned to normal level.There was no significant difference before and after IL-4 treatment(P>0.05).There were no regular changes in 7 cytokines before and 2 and 6 months after treatment in the non-negative culture group.Conclusion CD 8+T cells in MDR-TB patients were higher than those in healthy control group before treatment(P<0.01),indicating that the immune system of patients had changed.For initial treatment group,the body releases a large amount of IFN-gamma before medical treatment.With the development treatment activities,and the IFN-gamma also gradually decreases.In retreatment group,because of tuberculosis infection in the past,memory T cells in vivo are rapidly activated and release
作者
叶静
孙海柏
杜钟珍
梅早仙
YE Jing;SUN Hai-bai;DU Zhong-zhen(Tianjin Haihe Hospital,Tianjin 300000,China)
出处
《吉林医学》
CAS
2020年第4期794-799,共6页
Jilin Medical Journal
基金
天津市卫生局科技基金[项目编号:2012KZ032]。
关键词
肺结核
耐多药结核
T细胞亚群
细胞因子
Tuberculosis
Multidrug-resistant tuberculosis
T cell subsets
Cell factor
