系统性红斑狼疮合并结核感染临床特征及外周血淋巴细胞亚群分析

doi:10.19982/j.issn.1000-6621.20220240

中国防痨杂志 ›› 2022, Vol. 44 ›› Issue (9): 911-916.doi: 10.19982/j.issn.1000-6621.20220240

系统性红斑狼疮合并结核感染临床特征及外周血淋巴细胞亚群分析

谢静仪¹, 邹瑞丰², 陈玉兰¹, 陈永¹, 刘冬舟¹, 洪小平¹()

¹暨南大学第二临床医学院/南方科技大学附属第一医院/深圳市人民医院风湿免疫科,深圳 518020
²暨南大学第二临床医学院/南方科技大学附属第一医院/深圳市人民医院龙华分院急诊科,深圳 518109

收稿日期:2022-06-22 出版日期:2022-09-10 发布日期:2022-09-05
通信作者: 洪小平 E-mail:hong_xiaoping@hotmail.com
基金资助:
深圳市“医疗卫生三名工程”项目(SZSM202111006);深圳市人民医院风湿免疫科临床重点专科(SZXK011)

Analysis of clinical features and peripheral lymphocyte subsets of systemic lupus erythematosus patients complicated with tuberculosis infection

Xie Jingyi¹, Zou Ruifeng², Chen Yulan¹, Chen Yong¹, Liu Dongzhou¹, Hong Xiaoping¹()

¹Department of Rheumatology and Immunology,the Second Clinical Medical College of Ji’nan University, the First Hospital Affiliated to Southern University of Science and Technology, Shenzhen People’s Hospital, Guangdong Province, Shenzhen 518020, China
²Department of Emergency, the Second Clinical Medical College of Ji’nan University, the First Hospital Affiliated to Southern University of Science and Technology, Shenzhen People’s Hospital Longhua Branch, Shenzhen People’s Hospital, Guangdong Province, Shenzhen 518109, China

Received:2022-06-22 Online:2022-09-10 Published:2022-09-05
Contact: Hong Xiaoping E-mail:hong_xiaoping@hotmail.com
Supported by:
Sanming Project of Medicine in Shenzhen(SZSM202111006);Key Clinical Specialty Project of Rheumatology and Immunology Department of Shenzhen People’s Hospital(SZXK011)

摘要/Abstract

摘要：

目的: 探讨系统性红斑狼疮(systemic lupus erythematosus,SLE)合并结核感染患者的临床特征及其外周血淋巴细胞亚群的特点。方法: 采用回顾性研究方法,搜集2015年1月至2021年12月深圳市人民医院收治并同时完成γ-干扰素释放试验及淋巴细胞亚群检测的287例SLE患者作为研究对象。其中,SLE合并活动性结核病者30例(结核病组),SLE合并结核分枝杆菌潜伏感染(latent tuberculosis infection,LTBI)者16例(LTBI组)。按SLE合并活动性结核病组1∶2的比例,选取同时期性别、年龄匹配的未合并结核分枝杆菌及其他病原体感染的SLE患者60例,作为未感染组。同时,从本院体检中心纳入性别、年龄与SLE合并活动性结核病组相匹配,并完成淋巴细胞亚群检测的健康成年人40名,作为对照组。收集研究对象临床特征、实验室检测结果及临床治疗资料等进行分析。结果: 结核病组的结核病病程为4.0(1.0,8.0)周,以合并单纯肺结核为主[17例(56.7%)]。结核病组的SLE病程为54.0(7.5,96.0)月,明显短于LTBI组[96.0(72.0,180.0)月],而出现间质性肺炎的比例[23.3%,7例]明显多于LTBI组(0.0%),差异均有统计学意义(Z=-2.832,P=0.005;χ²=4.403,P=0.036)。与未感染组相比,结核病组的CD3⁺ T细胞计数[(766±480)个/μl vs. (1146±636)个/μl]、CD4⁺ T细胞计数[(370±278)个/μl vs.(517±291)个/μl]和CD8⁺ T细胞计数[376(244,421)个/μl vs.420(322,742)个/μl]明显降低,差异均有统计学意义(t=-2.875,P=0.005;t=-2.298,P=0.024;Z=-2.842,P=0.004)。3组SLE患者的淋巴细胞亚群比例均无明显差异。结论: SLE患者合并的结核感染多累及肺部;SLE合并活动性结核病患者发生间质性肺炎的比例较高。临床治疗中,如SLE患者出现T淋巴细胞减少,尤其CD8⁺ T细胞严重减少时,应警惕结核感染。

关键词: 红斑狼疮,系统性, 分枝杆菌,结核, 疾病特征, 淋巴细胞亚群, 回顾性研究

Abstract:

Objective: To investigate the clinical features and characteristics of peripheral blood lymphocyte subsets in systemic lupus erythematosus (SLE) patients complicated with tuberculosis infection. Methods: A retrospective study was conducted in 287 SLE patients who were admitted to Shenzhen People’s Hospital and completed the interferon-gamma release assays and lymphocyte subset detection from January 2015 to December 2021. Among them, 30 cases complicated with active tuberculosis, and 16 cases complicated with latent tuberculosis infection (LTBI). According to the ratio of 1∶2 in the group of SLE complicated with active tuberculosis, 60 patients with SLE not infected with Mycobacterium tuberculosis or other pathogens in the same period were selected as the uninfected group. Meanwhile, 40 healthy volunteers who matched the gender and age of the SLE patients complicated with active tuberculosis and completed the detection of lymphocyte subsets from the health screen center of our hospital were selected as the control group. The clinical features, laboratory test results and clinical treatment were collected and analyzed. Results: The duration of tuberculosis in active tuberculosis group was 4.0 (1.0, 8.0) weeks, and mainly complicated with pulmonary tuberculosis alone (17 cases, 56.7%). The duration of SLE in the active tuberculosis group was 54.0 (7.5, 96.0) months, which was significantly shorter than that of the LTBI group (96.0 (72.0, 180.0) months; Z=-2.832, P=0.005), and the proportion of interstitial pneumonia (7 cases, 23.3%) was significantly higher than that in the LTBI group (0.0%; χ²=4.403, P=0.036). Compared with the uninfected group, CD3⁺ T cell count ((766±480) cells/μl vs. (1146±636) cells/μl), CD4⁺ T cell count ((370±278) cells/μl vs. (517±291) cells/μl) and CD8⁺ T cell counts (376 (244, 421) cells/μl vs. 420 (322, 742) cells/μl) in tuberculosis group were significantly decreased, and the difference was statistically significant (t=-2.875, P=0.005; t=-2.298, P=0.024; Z=-2.842, P=0.004, respectively). There was no significant difference in the proportion of lymphocyte subsets in the three groups of SLE patients. Conclusion: Tuberculosis infection in SLE patients were mainly in the lungs. The incidence of interstitial pneumonia in SLE patients complicated with active tuberculosis was higher. In clinical treatment, if there is a decrease in T lymphocytes in SLE patients, especially when CD8⁺ T cells are significantly decreased, we should be alert whether complicated with tuberculosis infection.

Key words: Lupus erythematosus,systemic, Mycobacterium tuberculosis, Disease attributes, Lymphocyte subsets, Retrospective studies

中图分类号:

R593
R52

谢静仪, 邹瑞丰, 陈玉兰, 陈永, 刘冬舟, 洪小平. 系统性红斑狼疮合并结核感染临床特征及外周血淋巴细胞亚群分析[J]. 中国防痨杂志, 2022, 44(9): 911-916. doi: 10.19982/j.issn.1000-6621.20220240

Xie Jingyi, Zou Ruifeng, Chen Yulan, Chen Yong, Liu Dongzhou, Hong Xiaoping. Analysis of clinical features and peripheral lymphocyte subsets of systemic lupus erythematosus patients complicated with tuberculosis infection[J]. Chinese Journal of Antituberculosis, 2022, 44(9): 911-916. doi: 10.19982/j.issn.1000-6621.20220240

图/表 3

表1

不同临床特征及实验室指标在系统性红斑狼疮组及对照组中的分布情况

因素	SLE合并活动性结核病组(30例)	SLE合并LTBI 组(16例)	SLE未合并感染组(60例)	对照组 (40名)	统计检验值	P值
年龄(岁, $x ¯$ ±s)	40.83±12.17	39.06±8.78	39.72±9.22	38.60±10.03	F=0.299	0.826
性别[例/名(构成比,%)]					χ²=0.157	0.984
男性	4(13.3)	2(12.5)	9(15.0)	5(12.5)
女性	26(86.7)	14(87.5)	51(85.0)	35(87.5)
SLE病程[月,M(Q₁,Q₃)]	54.0(7.5,96.0)	96.0(72.0,180.0)	96.0(24.0,147.0)	-	Z=6.832	0.033
糖皮质激素累计使用剂量[g, M(Q₁,Q₃)]	9.06(1.80,17.79)	24.74(6.41,34.98)	18.19(7.30,34.55)	-	Z=5.138	0.077
免疫抑制剂疗程[月,M(Q₁,Q₃)]	18.0(0.5,46.0)	27.0(12.0,66.0)	36.0(0.5,102.0)	-	Z=1.902	0.386
脏器受累[例(构成比,%)]	22(73.3)	12(75.0)	50(83.3)	-	χ²=1.423	0.491
肾脏受累[例(构成比,%)]	10(33.3)	7(43.8)	32(53.3)	-	χ²=3.265	0.195
血液系统受累[例(构成比,%)]	8(26.7)	8(50.0)	21(35.0)	-	χ²=2.501	0.286
间质性肺炎[例(构成比,%)]	7(23.3)	0(0.0)	5(8.3)	-	χ²=6.888	0.032
肺动脉高压[例(构成比,%)]	2(6.7)	1(6.3)	3(5.0)	-	χ²=0.116	0.944
神经系统受累[例(构成比,%)]	2(6.7)	2(12.5)	3(5.0)	-	χ²=1.152	0.562
SLEDAI-2000评分[分,M(Q₁,Q₃)]	4.0(2.0,6.0)	4.0(2.0,6.5)	4.5(2.0,7.3)	-	Z=2.394	0.302
重度活动[例(构成比,%)]	3(10.0)	0(0.0)	1(1.7)	-	χ²=4.564	0.102
中度活动[例(构成比,%)]	2(6.7)	2(12.5)	8(13.3)	-	χ²=0.912	0.634
轻度活动[例(构成比,%)]	4(13.3)	5(31.3)	21(35.0)	-	χ²=4.708	0.095
无活动[例(构成比,%)]	21(70.0)	9(56.3)	30(50.0)	-	χ²=3.258	0.196
hsCRP[mg/L,M(Q₁,Q₃)]	25.95(4.00,48.61)	3.29(1.09,5.00)	1.13(0.49,3.73)	-	Z=23.027	<0.001
ESR[mm/1h,M(Q₁,Q₃)]	46.00(31.00,72.25)	18.50(7.75,35.25)	20.00(7.75,30.25)	-	Z=11.588	0.003
补体3(g/L, $x ¯$ ±s)	0.82±0.38	0.74±0.33	0.73±0.29	-	F=0.879	0.418
补体4[g/L,M(Q₁,Q₃)]	0.16(0.09,0.23)	0.08(0.05,0.13)	0.13(0.07,0.22)	-	Z=3.098	0.212
IgG(g/L, $x ¯$ ±s)	16.32±6.17	13.36±8.47	13.34±5.09	-	F=2.636	0.076

表1

表2

外周血淋巴细胞亚群计数在系统性红斑狼疮组及对照组中的分布情况

淋巴细胞亚群计数 (个/μl)	SLE合并活动性结核病组(30例)	SLE合并LTBI 组(16例)	SLE未合并感染组(60例)	对照组 (40名)	统计检验值	P值
总淋巴细胞( $x ¯$ ±s)	1051±705	1546±826	1461±744	1949±603	F=9.273	<0.001
CD3⁺ T细胞( $x ¯$ ±s)	766±480	1228±544	1146±636	1424±488	F=8.011	<0.001
CD4⁺ T细胞( $x ¯$ ±s)	370±278	638±378	517±291	827±311	F=14.605	<0.001
CD8⁺ T细胞[M(Q₁,Q₃)]	376(244,421)	439(289,640)	420(322,742)	451(368,582)	Z=10.287	0.016
CD19⁺ B细胞[M(Q₁,Q₃)]	93(30,186)	82(48,154)	140(70,259)	268(157,321)	Z=23.391	<0.001
NK细胞( $x ¯$ ±s)	121±111	105±81	125±125	245±143	F=9.922	<0.001

表2

表3

参考文献 16

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淋巴细胞亚群比例 [%,M(Q₁,Q₃)]	SLE合并活动性结核病组(30例)	SLE合并LTBI 组(16例)	SLE未合并感染组(60例)	对照组 (40名)	Z值	P值
CD3⁺ T细胞	74.35(65.50,81.18)	84.70(76.10,89.45)	79.50(71.55,86.08)	73.75(69.22,78.85)	13.948	0.003
CD4⁺ T细胞	31.20(27.10,39.02)	39.20(35.80,45.95)	35.30(27.5,42.58)	42.2(37.78,46.82)	19.566	<0.001
CD8⁺ T细胞	30.45(24.45,43.12)	36.00(21.78,48.42)	35.15(29.72,43.42)	24.25(20.85,30.12)	34.383	<0.001
CD19⁺ B细胞	9.65(6.80,16.72)	6.25(4.58,9.65)	10.70(6.35,16.95)	13.50(9.78,15.92)	8.482	0.037
NK细胞	11.80(5.12,16.95)	5.65(2.80,11.20)	7.00(3.92,10.90)	11.85(7.48.16.70)	19.207	<0.001

系统性红斑狼疮合并结核感染临床特征及外周血淋巴细胞亚群分析

Analysis of clinical features and peripheral lymphocyte subsets of systemic lupus erythematosus patients complicated with tuberculosis infection

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