老年耐多药肺结核患者免疫功能特点的观察
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摘要
目的探讨免疫功能指标变化与老年肺结核患者耐多药的相关性,为临床上结核病的治疗提供重要的理论依据。方法选取我院老年耐多药肺结核(MDR-TB)患者120例,为MDR-TB组,老年药物敏感性结核患者80例,为敏感肺结核组,健康的体检对象80例,为对照组,中青年MDR-TB患者80例,为中青MDR-TB组,选取时间2015年5月-2017年5月。流式细胞术分析淋巴细胞CD4~+和CD8~+的比例,酶联免疫吸附法(ELISA)检测血清中的细胞因子,比较老年耐多药结核病患者血清学与老年药敏结核病患者血清、正常人血清之间的差异。结果各组间CD3~+分子的百分比相比较,差异无统计学意义,各结核组CD4~+、CD4~+/CD8~+百分比显著低于对照组,CD8~+百分比显著高于对照组,差异有统计学意义(P<0.05),耐多药结核组与敏感肺结核组CD4~+、CD8~+、CD4~+/CD8~+百分比相比差异具有统计学意义(P<0.05);老年MDR-TB组CD4~+、CD4~+/CD8~+百分比显著低于中青年组MDR-TB组,CD8~+百分比显著高于中青年组MDR-TB组,差异有统计学意义(P<0.05);各结核组IFN-γ、IL-2显著低于对照组,IL-4、IL-10显著高于对照组,差异具有统计学意义(P<0.05),MDR-TB组与敏感肺结核组及中青年组MDR-TB组IFN-γ、IL-2、IL-4、IL-10差异有统计学意义(P<0.05);各结核组Ig G、Ig M、Ig A明显低于对照组(P<0.05),MDR-TB组与敏感肺结核组及中青年组MDR-TB组Ig G、Ig M、Ig A差异有统计学意义(P<0.05)。结论老年肺结核病患者细胞免疫功能均下降,老年耐多药结核病患者较老年敏感结核病患者及中青年耐多药结核病患者的细胞免疫功能下降更加明显。
Objective To study the correlation between the change of immune function index and the patients with multi-drug resistant pulmonary tuberculosis, in order to provide important theoretical basis for clinical prevention and treatment. Methods 120 patients with drug-resistant pulmonary tuberculosis(MDR-TB) were selected as the MDR-TB group, 80 patients with drug-sensitive tuberculosis as the sensitive group and 80 healthy subjects as the control group from May 2015 to May 2017. Lymphocyte subsets were analyzed by flow cytometry, and serum cytokines were detected by Elisa. The serum levels of serum cytokines in patients with MDR-TB were compared with those in patients with drug-sensitive tuberculosis and normal people. Results There was no significant difference in the percentage of CD3~+ molecules among the three groups. The percentage of CD4~+ and CD4~+/CD8~+ in each tuberculosis group was significantly lower than that in the control group, and the percentage of CD8~+ was significantly higher than that of the control group(P<0.05). The percentage of CD4~+, CD8~+, and CD4~+/CD8~+ in the MDR-TB group was significantly higher than that in the susceptible TB group(P<0.05), and the percentage of CD4~+/CD8~+ in the elderly MDR-TB group was significantly lower than that in the middle-aged MDR-TB group(P<0.05). The levels of IFN-γ and IL-2 in each tuberculosis group were significantly lower than those in the control group. IL-4 and IL-10 were significantly higher than in the control group( P<0.05). The difference of IL-10 between the MDR-TB group and the tuberculosis sensitive group and the young and middle-aged MDR-TB group was statistically significant(P<0.05). The level of Ig G, Ig M and Ig A in each tuberculosis group was significantly lower than that in the control group(P<0.05). The difference between the MDR-TB group and the tuberculosis sensitive group and the young and middle-aged MDR-TB group was statistically significant(P<0.05). Conclusion The cellular immune function of elderly patients with tuberculosis decreases,and the cellular immune function of the elderly patients with MDR-TB is significantly lower than that of the elderly patients with MDR-TB and the young and middle-aged patients with MDR-TB.
Objective To study the correlation between the change of immune function index and the patients with multi-drug resistant pulmonary tuberculosis, in order to provide important theoretical basis for clinical prevention and treatment. Methods 120 patients with drug-resistant pulmonary tuberculosis(MDR-TB) were selected as the MDR-TB group, 80 patients with drug-sensitive tuberculosis as the sensitive group and 80 healthy subjects as the control group from May 2015 to May 2017. Lymphocyte subsets were analyzed by flow cytometry, and serum cytokines were detected by Elisa. The serum levels of serum cytokines in patients with MDR-TB were compared with those in patients with drug-sensitive tuberculosis and normal people. Results There was no significant difference in the percentage of CD3~+ molecules among the three groups. The percentage of CD4~+ and CD4~+/CD8~+ in each tuberculosis group was significantly lower than that in the control group, and the percentage of CD8~+ was significantly higher than that of the control group(P<0.05). The percentage of CD4~+, CD8~+, and CD4~+/CD8~+ in the MDR-TB group was significantly higher than that in the susceptible TB group(P<0.05), and the percentage of CD4~+/CD8~+ in the elderly MDR-TB group was significantly lower than that in the middle-aged MDR-TB group(P<0.05). The levels of IFN-γ and IL-2 in each tuberculosis group were significantly lower than those in the control group. IL-4 and IL-10 were significantly higher than in the control group( P<0.05). The difference of IL-10 between the MDR-TB group and the tuberculosis sensitive group and the young and middle-aged MDR-TB group was statistically significant(P<0.05). The level of Ig G, Ig M and Ig A in each tuberculosis group was significantly lower than that in the control group(P<0.05). The difference between the MDR-TB group and the tuberculosis sensitive group and the young and middle-aged MDR-TB group was statistically significant(P<0.05). Conclusion The cellular immune function of elderly patients with tuberculosis decreases,and the cellular immune function of the elderly patients with MDR-TB is significantly lower than that of the elderly patients with MDR-TB and the young and middle-aged patients with MDR-TB.
引文
[1] 吴雪琼.重视并进一步探索结核病的免疫治疗[J].中国防痨杂志,2017,39(2):111-113.
[2] 刘宁,付洪义,苏明霞,等.肺结核患者肺泡灌洗液T淋巴细胞亚群水平检测意义[J].基因组学与应用生物学,2016,35(11):2930-2934.
[3] 任易,彭孝红,徐晶,等.肺结核和肺外结核患者外周血淋巴细胞亚群及血液相关指标的变化比较[J].医学临床研究,2017,34(1):173-175.
[4] 夏宁,张宇,侯志波,等.肺结核患者T细胞亚群比例和相关细胞因子的动态变化及临床意义[J].江苏医药,2015,41(22):2684-2687.
[5] 邹级谦.肺结核诊断标准[S].结核病健康教育,2008,31(1):7-9.
[6] 中国防痨协会.耐药结核病化学治疗指南(2015)[S].中国防痨杂志,2015,37(5):421-469.
[7] 宋瑞娟,夏露,卢水华.糖尿病与耐药肺结核的关系[J].中国防痨杂志,2017,39(1):11-15.
[8] CACCAMO N,PIETRA G,SULLIVAN L C,et al.Human CD8 T lymphocytes recognize Mycobacterium tuberculosis antigens presented by HLA-E during active tuberculosis and express type 2 cytokines[J].Eur J Immunol,2015,45(4):1069-1081.
[9] 凌应冰,谢鸿恩,卢艳春.莫西沙星联合微卡治疗复治耐多药肺结核患者的临床疗效及免疫功能观察[J].中国实用医药,2017,12(5):133-135.
[10] 范琳.耐多药肺结核的免疫治疗研究进展[J].中国防痨杂志,2015,37(11):1144-1149.
[11] WANG J,YIN Y,WANG X,et al.Ratio of monocytes to lymphocytes in peripheral blood in patients diagnosed with active tuberculosis[J].Braz J Infect Dis,2015,19(2):125-131.
[12] YAO S,HUANG D,CHEN C Y,et al.CD4+ T cells contain early extrapulmonary tuberculosis (TB) dissemination and rapid TB progression and sustain multieffector functions of CD8+ T and CD3- lymphocytes:mechanisms of CD4+ T cell immunity[J].J Immunol,2014,192(5):2120-2132.
[13] 胡永芳,张汇征,刘家秀,等.耐多药肺结核患者血CD4细胞计数及痰菌分离鉴定和药物敏感性试验分析[J].中国防痨杂志,2015,37(4):360-365.
[14] 雷鸣.普通肺结核与耐多药肺结核T淋巴细胞亚群的临床特征[J].中国实用医刊,2016,43(18):80-81.
[15] 兰远波,刘梅,张建勇,等.老年肺结核患者临床及耐药特征分析[J].中国老年学杂志,2015,35(18):5203-5204.
[16] 王红岩,柴文戍,李志江,等.老年肺结核合并下呼吸道感染的病原菌分布及其耐药性[J].中国老年学杂志,2016,36(3):657-659.
[2] 刘宁,付洪义,苏明霞,等.肺结核患者肺泡灌洗液T淋巴细胞亚群水平检测意义[J].基因组学与应用生物学,2016,35(11):2930-2934.
[3] 任易,彭孝红,徐晶,等.肺结核和肺外结核患者外周血淋巴细胞亚群及血液相关指标的变化比较[J].医学临床研究,2017,34(1):173-175.
[4] 夏宁,张宇,侯志波,等.肺结核患者T细胞亚群比例和相关细胞因子的动态变化及临床意义[J].江苏医药,2015,41(22):2684-2687.
[5] 邹级谦.肺结核诊断标准[S].结核病健康教育,2008,31(1):7-9.
[6] 中国防痨协会.耐药结核病化学治疗指南(2015)[S].中国防痨杂志,2015,37(5):421-469.
[7] 宋瑞娟,夏露,卢水华.糖尿病与耐药肺结核的关系[J].中国防痨杂志,2017,39(1):11-15.
[8] CACCAMO N,PIETRA G,SULLIVAN L C,et al.Human CD8 T lymphocytes recognize Mycobacterium tuberculosis antigens presented by HLA-E during active tuberculosis and express type 2 cytokines[J].Eur J Immunol,2015,45(4):1069-1081.
[9] 凌应冰,谢鸿恩,卢艳春.莫西沙星联合微卡治疗复治耐多药肺结核患者的临床疗效及免疫功能观察[J].中国实用医药,2017,12(5):133-135.
[10] 范琳.耐多药肺结核的免疫治疗研究进展[J].中国防痨杂志,2015,37(11):1144-1149.
[11] WANG J,YIN Y,WANG X,et al.Ratio of monocytes to lymphocytes in peripheral blood in patients diagnosed with active tuberculosis[J].Braz J Infect Dis,2015,19(2):125-131.
[12] YAO S,HUANG D,CHEN C Y,et al.CD4+ T cells contain early extrapulmonary tuberculosis (TB) dissemination and rapid TB progression and sustain multieffector functions of CD8+ T and CD3- lymphocytes:mechanisms of CD4+ T cell immunity[J].J Immunol,2014,192(5):2120-2132.
[13] 胡永芳,张汇征,刘家秀,等.耐多药肺结核患者血CD4细胞计数及痰菌分离鉴定和药物敏感性试验分析[J].中国防痨杂志,2015,37(4):360-365.
[14] 雷鸣.普通肺结核与耐多药肺结核T淋巴细胞亚群的临床特征[J].中国实用医刊,2016,43(18):80-81.
[15] 兰远波,刘梅,张建勇,等.老年肺结核患者临床及耐药特征分析[J].中国老年学杂志,2015,35(18):5203-5204.
[16] 王红岩,柴文戍,李志江,等.老年肺结核合并下呼吸道感染的病原菌分布及其耐药性[J].中国老年学杂志,2016,36(3):657-659.
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