肺结核及肺外结核患者外周血T淋巴细胞亚群的变化及其临床意义

doi:10.3969/j.issn.1000-6621.2019.10.005

摘要/Abstract

摘要：

目的探讨肺外结核患者外周血CD3 ⁺、CD4 ⁺、CD8 ⁺T淋巴细胞亚群及CD4 ⁺/CD8 ⁺比值的变化及其临床意义方法搜集2017年11月至2019年1月在成都市公共卫生临床医疗中心结核病区住院的147例患者(包括63例单纯肺结核、60例肺结核并发肺外结核和24例单纯肺外结核患者,分别为肺结核组、肺结核并发肺外结核组和肺外结核组)作为研究对象。采用流式细胞仪及四色淋巴细胞亚群检测试剂盒检测纳入的各组患者外周血CD3 ⁺、CD4 ⁺、CD8 ⁺T淋巴细胞的绝对计数及CD4 ⁺/CD8 ⁺比值,分析上述各组患者外周血T淋巴细胞亚群的差异。结果肺结核并发肺外结核患者外周血CD3 ⁺和CD4 ⁺T淋巴细胞计数分别为596.000(377.500,823.250)个/μl和347.500(214.000,479.250)个/μl,均低于单纯肺结核患者的698.000(572.000,904.000)个/μl和409.000(311.000,545.000)个/μl,差异均有统计学意义(Z=-2.507,P=0.012;Z=-2.431,P=0.015)。肺结核并发肺外结核患者的CD8 ⁺T淋巴细胞计数与CD4 ⁺/CD8 ⁺比值分别为195.500(137.250,278.750)个/μl和1.670(1.258,2.273),较肺结核患者的244.000(154.000,317.000)个/μl和1.770(1.290,2.350)降低,但差异均无统计学意义(Z=-1.892,P=0.058;Z=-0.546,P=0.585)。单纯肺外结核患者外周血CD3 ⁺和CD4 ⁺ T淋巴细胞计数分别为551.500(283.750,949.000)个/μl和295.500(134.250,461.750)个/μl,低于单纯肺结核患者的698.000(572.000,904.000)个/μl和409.000(311.000,545.000)个/μl,差异均有统计学意义(Z=-2.089,P=0.037;Z=-2.460,P=0.014);单纯肺外结核患者外周血的CD8 ⁺T淋巴细胞计数[185.000(92.000,366.250)个/μl]及CD4 ⁺/CD8 ⁺比值[1.455(1.018,2.128)]与单纯肺结核患者[分别为244.000(154.000,317.000)个/μl和1.770(1.290,2.350)]相比,差异均无统计学意义(Z=-1.315,P=0.188;Z=-1.429,P=0.153)。结论随着肺结核患者外周血CD3 ⁺、CD4 ⁺ T淋巴细胞计数的逐步降低,结核分枝杆菌可能更易播散至肺外;外周血CD8 ⁺T淋巴细胞计数及CD4 ⁺/CD8 ⁺比值在肺外结核发生机制中的作用尚需进一步探讨。

关键词: 结核, 肺, T淋巴细胞亚群, 细胞计数, CD4-CD8比值, 数据说明, 统计, 结核, 肺外

Abstract:

Objective To investigate the changes of CD3 ⁺, CD4 ⁺, and CD8 ⁺ T lymphocyte subsets as well as CD4 ⁺/CD8 ⁺ ratio in peripheral blood and its clinical significance in patients with extra-pulmonary tuberculosis (EPTB).Methods A total of 147 patients, including 63 cases of pulmonary tuberculosis (PTB), 60 cases of PTB combined with EPTB (PTB&EPTB) and 24 cases of EPTB, who hospitalized in the tuberculosis area in the Public Health Clinical Center of Chengdu from October 2017 to January 2019 were enrolled in this study. The absolute counts of CD3 ⁺, CD4 ⁺ and CD8 ⁺ T lymphocyte subsets in peripheral blood and the ratio of CD4 ⁺/CD8 ⁺ were detected by flow cytometry and four-color lymphocyte subset detection kit. Then the differences of CD3 ⁺, CD4 ⁺ and CD8 ⁺ counts combined with the ratio of CD4 ⁺/CD8 ⁺ between groups were analyzed.Results CD3 ⁺ and CD4 ⁺ counts in the peripheral blood of patients with PTB&EPTB were 596.000 (377.500, 823.250) cells/μl and 347.500 (214.000, 479.250) cells/μl, respectively, which were significantly lower than those in patients with PTB (698.000 (572.000, 904.000) cells/μl and 409.000 (311.000, 545.000) cells/μl) (Z=-2.507, P=0.012; and Z=-2.431, P=0.015, respectively). The CD8 ⁺ count and the ratio of CD4 ⁺/CD8 ⁺ in patients with PTB&EPTB were 195.500 (137.250, 278.750) cells/μl and 1.670 (1.258, 2.273), respectively, were decreased compared with patients with PTB (244.000 (154.000, 317.000) cells/μl and 1.770 (1.290, 2.350)), while without statistically significant difference (Z=-1.892, P=0.058; Z=-0.546, P=0.585, respectively). In addition, CD3 ⁺ and CD4 ⁺counts in the peripheral blood of patients with EPTB were 551.500 (283.750, 949.000) cells/μl and 295.500 (134.250, 461.750) cells/μl, were significantly lower compared to patients with PTB (698.000 (572.000, 904.000) cells/μl and 409.000 (311.000, 545.000) cells/μl) (Z=-2.089, P=0.037; and Z=-2.460, P=0.014, respectively). However, the CD8 ⁺ counts and the ratio of CD4 ⁺/CD8 ⁺ presented no significant difference (Z=-1.315, P=0.188; and Z=-1.429, P=0.153, respectively) between patients with EPTB (185.000 (92.000, 366.250) cells/μl and 1.455 (1.018, 2.128)) and patients with PTB (244.000 (154.000, 317.000) cells/μl and 1.770 (1.290, 2.350)).Conclusion With the gradual decrease of CD3 ⁺ and CD4 ⁺ counts in the peripheral blood of patients with PTB, Mycobacterium tuberculosis may more easily disseminate to the outside of the lung, while the roles of CD8 ⁺ counts and the ratio of CD4 ⁺/CD8 ⁺ in the mechanism of EPTB still need to be further explored.

Key words: Tuberculosis, pulmonary, T-lymphocyte subsets, Cell count, CD4-CD8 ratio, Data interpretation, statistical, Tuberculosis, extra-pulmonary

何畏,陈晴,黄涛,黄晓秋,吴桂辉. 肺结核及肺外结核患者外周血T淋巴细胞亚群的变化及其临床意义[J]. 中国防痨杂志, 2019, 41(10): 1090-1095. doi: 10.3969/j.issn.1000-6621.2019.10.005

Wei HE,Qing CHEN,Tao HUANG,Xiao-qiu HUANG,Gui-hui WU. The changes in peripheral blood of T lymphocyte subsets in patients with pulmonary tuberculosis and extra-pulmonary tuberculosis and its clinical significance[J]. Chinese Journal of Antituberculosis, 2019, 41(10): 1090-1095. doi: 10.3969/j.issn.1000-6621.2019.10.005

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临床参数	肺结核 (63例)	肺结核并发肺外结核(60例)	肺外结核 (24例)	统计检验值	P值
平均年龄[岁,M(Q₁,Q₃)]	37.00(22.00,59.00)	33.50(22.00,47.00)	36.50(22.50,53.00)	H=0.790	0.674
性别[例数,构成比(%)]				χ²=0.604	0.739
男	39(61.9)	33(55.0)	14(58.3)
女	24(38.1)	27(45.0)	10(41.7)

组别	例数	CD3⁺ [个/μl,M(Q₁,Q₃)]	CD4⁺ [个/μl,M(Q₁,Q₃)]	CD8⁺ [个/μl,M(Q₁,Q₃)]	CD4⁺/CD8⁺ [M(Q₁,Q₃)]
肺结核	63	698.000 (572.000,904.000)	409.000 (311.000,545.000)	244.000 (154.000,317.000)	1.770 (1.290,2.350)
肺结核并发肺外结核	60	596.000 (377.500,823.250)	347.500 (214.000,479.250)	195.500 (137.250,278.750)	1.670 (1.258,2.273)
肺外结核	24	551.500 (283.750,949.000)	295.500 (134.250,461.750)	185.000 (92.000,366.250)	1.455 (1.018,2.128)
H值		8.900	8.989	4.506	2.132
P值		0.012	0.011	0.105	0.344