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中国防痨杂志 ›› 2019, Vol. 41 ›› Issue (12): 1263-1268.doi: 10.3969/j.issn.1000-6621.2019.12.006

• 论著 • 上一篇    下一篇

T淋巴细胞检测对非结核分枝杆菌病的诊断价值

黄芳(),王勃,赵国连,王海东,党丽云   

  1. 710100 西安市胸科医院
  • 收稿日期:2019-08-18 出版日期:2019-12-10 发布日期:2019-12-13
  • 通信作者: 黄芳 E-mail:fklsuijk@163.com
  • 基金资助:
    西安市卫生和计划生育委员会卫生科研人才培训项目(J201702023)

Diagnosis value of T lymphocyte detection for non-tuberculous mycobacteria diseases

Fang HUANG(),Bo WANG,Guo-lian ZHAO,Hai-dong WANG,Li-yun DANG   

  1. Xi’an Chest Hospital,Xi’an 710100,China
  • Received:2019-08-18 Online:2019-12-10 Published:2019-12-13
  • Contact: Fang HUANG E-mail:fklsuijk@163.com

摘要:

目的 分析应用流式细胞学检测T淋巴细胞在非结核分枝杆菌(NTM)病诊断中的价值。方法 收集2013年1月至2019年3月西安市胸科医院经临床综合诊断确诊的162例NTM肺病(NTM组)、143例菌阳肺结核(肺结核组)、146例结核性胸膜炎(结核性胸膜炎组)、81例结核性脑膜炎(结核性脑膜炎组)、175例其他肺部疾病(对照组,包括细菌性肺炎101例、支原体肺炎58例、支气管扩张症11例、尘肺5例)患者的T淋巴细胞流式细胞检查结果并进行比对分析,总结流式细胞学检测NTM肺病患者T淋巴细胞的特点。应用SPSS 23.0软件进行统计学方析,非正态分布的计量资料以中位数(四分位数)[M(Q1,Q3)]表示,采用非参数Kruskal-Waills H检验比较5组患者,以及NTM组分别与其他4组患者T淋巴细胞流式细胞检查结果的差异,以P<0.05为差异有统计学意义。结果 NTM组、肺结核组、结核性胸膜炎组、结核性脑膜炎组、对照组患者的总T淋巴细胞计数分别为1276.00(987.00,1563.00)、907.00(661.00,1231.25)、793.00(556.50,1080.75)、574.00 (296.00,883.00)、1904.00 (1611.50,2093.50)个/μl,CD4 +T淋巴细胞计数分别为868.00(599.00,997.00)、546.00(384.75,744.00)、445.00(301.75,645.00)、294.00 (134.00,462.00)、1497.00 (925.50,1757.50)个/μl,CD8 + T淋巴细胞计数分别为369.00(252.00,573.00)、289.50(192.00,400.75)、303.50(206.75,441.00)、243.00(119.00,427.00)、417.00(279.50,644.50)个/μl,CD4 +CD8 + T淋巴细胞计数分别为11.00(7.00,18.00)、6.00(4.00,11.00)、8.00(6.00,13.00)、5.00(2.00,9.00)、9.00(6.00,12.50)个/μl,各组数据均以对照组最高,NTM组次之,各结核病组最低;且5组间及NTM组与肺结核组、结核性胸膜炎组、结核性脑膜炎组、对照组患者在总T淋巴细胞、CD4 + T淋巴细胞、CD8 +T淋巴细胞数值的差异均有统计学意义(H=339.898、5.291、6.968、8.323、-7.662,P值均=0.000;H=384.960、5.973、8.777、10.128、-6.641,P值均=0.000;H=66.345、4.632、3.503、5.530、-0.897,P值均<0.05), 5组间及NTM与肺结核组、结核性胸膜炎组、结核性脑膜炎组患者在CD4 +CD8 + T淋巴细胞差异均有统计学意义(H=59.508、5.453、3.189、6.824,P值均=0.000)。 结论 NTM肺病患者T淋巴细胞计数低于其他肺部疾病(对照组)患者,高于3组结核病患者,可辅助判断患者免疫状况,具有一定的辅助诊断价值。

关键词: 分枝杆菌感染,非典型性, 肺疾病, 流式细胞术, 淋巴细胞计数, 诊断,鉴别, 数据说明,统计

Abstract:

Objective To evaluate the value of T lymphocytes detection by flow cytometry in the diagnosis of non-tuberculosis mycobacteria (NTM) disease.Methods Totally, 162 cases of NTM pulmonary disease (NTM group), 143 cases of bacterial positive pulmonary tuberculosis (PTB group), 146 cases of tuberculous pleurisy (tuberculous pleurisy group),81 cases of tuberculous meningitis (tuberculous meningitis group) and 175 cases of other pulmonary diseases (control group, including 101 patients with bacterial pneumonia, 58 patients with mycoplasma pneumonia, 11 patients with bronchiectasis and 5 patients with pneumoconiosis) were retrospectively collected in Xi’an Chest Hospital from January 2013 to March 2019. The results of T lymphocytes detected by flow cytometry in 5 groups were summarized and comparatively analyzed. SPSS 23.0 software was used to statistically analysis, and the measurement data of non-normal distribution were expressed by median (quartile) (M(Q1,Q3)). Kruskal-Waills H test was used to compare the differences of T lymphocyte flow cytometry results between 5 groups as well as between the NTM group and other groups. P<0.05 was considered statistically significant.Results In the NTM group, PTB group, tuberculous pleurisy group, tuberculous meningitis group and control group, the total T lymphocytes were 1276.00 (987.00,1563.00),907.00 (661.00,1231.25),793.00 (556.50,1080.75),574.00 (296.00,883.00),and 1904.00 (1611.50,2093.50)cells/μl; CD4 + T lymphocyte counts were 868.00 (599.00,997.00),546.00 (384.75,744.00),445.00 (301.75,645.00),294.00 (134.00,462.00),and 1497.00 (925.50,1757.50) cells/μl;CD8 + T lymphocyte counts were 369.00 (252.00,573.00), 289.50 (192.00,400.75), 303.50 (206.75,441.00),243.00 (119.00,427.00), and 417.00 (279.50,644.50) cells/μl; and CD4 +CD8 + T lymphocytes counts were 11.00 (7.00, 18.00), 6.00 (4.00, 11.00), 8.00 (6.00, 13.00), 5.00 (2.00, 9.00), and 9.00 (6.00, 12.50) cells/μl. The data of each group were the highest in the control group, followed by the NTM group, and the lowest in each tuberculosis groups. There were significant differences in total T lymphocytes, CD4 + and CD8 + T lymphocytes among the five groups as well as between NTM group and PTB group, tuberculous pleurisy group, tuberculous meningitis group and control group (H=339.898, 5.291, 6.968, 8.323, -7.662, Ps=0.000; H=384.960, 5.973, 8.777, 10.128, -6.641, Ps=0.000; H=66.345, 4.632, 3.503, 5.530, -0.897, Ps=0.000, respectively). There were significant differences in CD4 +/CD8 + among the five groups as well as between NTM group and PTB group, tuberculous pleurisy group, and tuberculous meningitis group (H=59.508, 5.453, 3.189, 6.824, Ps<0.05). Conclusion The number of T lymphocytes in patients with NTM disease is lower than that in patients with other pulmonary diseases (control group), and higher than that in patients with tuberculosis in three groups. It can be used to judge the immune status of patients and has a certain auxiliary diagnostic value.

Key words: Mycobacterium infections,atypical, Lung diseases, Flow cytometry, Lymphocyte count, Diagnosis differential, Data interpretation,statistical