Analysis of three immunological indicators in rheumatic patients complicated with pulmonary tuberculosis

doi:10.3969/j.issn.1000-6621.2020.10.014

Abstract

Abstract:

Objective To investigate the characteristics of immunological indicators of rheumatic patients complicated with pulmonary tuberculosis. Methods A total of 117 rheumatic patients complicated with pulmonary tuberculosis from PLA Institute of Tuberculosis, the 8th Medical Center of Chinese PLA Hospital between July 2017 and July 2019 were selected as the observation group, and 117 patients with pulmonary tuberculosis alone during the same period were randomly selected by systematic sampling method as the control group. The positive rate of TB antibody test, the positive rate of IGRA and the count of T lymphocyte subsets of the two groups were compared. Results The positive rates of TB antibody (38 kD+16 kD)(1 kD=1000 relative molecular mass) and TB antibody 38 kD in the observation group were significantly lower than those in the control group (6.84% (8/117) vs. 33.33% (39/117), χ ²=25.59, P=0.000;21.37% (25/117) vs. 71.79% (84/117), χ ²=59.78, P=0.000). The difference of positive rate of IGRA in two groups was not significant (57.26% (67/117) in the observation group and 55.56% (65/117) in the control group, χ ²=0.70, P=0.792). As to the detection of lymphocyte subsets, peripheral blood CD4 ⁺ cell count (median (quartiles)) and CD4⁺/CD8⁺ value (median (quartiles)) in the observation group were significantly higher than those in the control group (513.00 (339.75, 844.50)/μl vs. 380.00 (320.00, 503.00)/μl, Z=2.11, P=0.035; 0.96 (0.74, 1.53) vs. 0.91 (0.74, 0.96), Z=4.90, P=0.000). However, peripheral blood CD8⁺ cell count (median (quartile)) in the observation group was significantly lower than that in the control group (377.50 (193.00,528.50)/μl vs. 475.00 (410.00,524.00)/μl, Z=2.27, P=0.023). Conclusion Compared to those of patients with pulmonary tuberculosis alone, the positive rate of TB antibody and CD8⁺ cell count in peripheral blood in rheumatic patients complicated with pulmonary tuberculosis were lower, while the CD4⁺ cell count in peripheral blood of rheumatic patients complicated with pulmonary tuberculosis was higher. The difference of positive rate of IGRA between rheumatic patients complicated with pulmonary tuberculosis and patients with tuberculosis alone was not significant.

Key words: Rheumatic diseases, Tuberculosis, pulmonary, Comorbidity, Laboratory techniques and procedures, Immunologic tests, Outcome assessment (health care), Comparative study

SHI Qian, CHEN Zhi. Analysis of three immunological indicators in rheumatic patients complicated with pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2020, 42(10): 1087-1091. doi: 10.3969/j.issn.1000-6621.2020.10.014

Figures/Tables 2

References 11

[1]	中华人民共和国国家卫生计划生育委员会. WS 288—2017 肺结核诊断. 2017-11-09.
[2]	Cárdenas-Roldán J, Rojas-Villarraga A, Anaya JM. How do autoimmune diseases cluster in families A systematic review and meta-analysis. BMC Med, 2013,11:73. doi: 10.1186/1741-7015-11-73. URL pmid: 23497011
[3]	Strehl C, Bijlsma JW, de Wit M, et al.Defining conditions where long-term glucocorticoid treatment has an acceptably low level of harm to facilitate implementation of existing recommendations: viewpoints from an EULAR task force. Ann Rheum Dis, 2016,75(6):952-957. doi: 10.1136/annrheumdis-2015-208916. doi: 10.1136/annrheumdis-2015-208916 URL pmid: 26933146
[4]	黄芳, 党丽云. 结核抗体检测辅助诊断结核病的价值研究. 中国防痨杂志, 2018,40(1):41-46. doi: 10.3969/j.issn.1000-6621.2018.01.011.
[5]	Villar-Hemandez R, Latorre I, Minquez S, et al. Use of IFN-γ and IP-10 detection in the diagnosis of latent tuberculosis infection in patients with inflammatory rheumatic diseases. J Infect, 2017,75(4):315-325. doi: 10.1016/j.jinf.2017.07.004. doi: 10.1016/j.jinf.2017.07.004 URL pmid: 28751171
[6]	Shim TS. Diagnosis and Treatment of Latent tuberculosis infection due to Initiation of Anti TNF Therapy. Tuberc Respir Dis (Seoul), 2014,76(6):261-268. doi: 10.4046/trd.2014.76.6.261.
[7]	Ruan Q, Zhang S, Ai J, et al. Screening of latent tuberculosis infection by interferon-γ release assays in rheumatic patients: a systemic review and meta-analysis. Clin Rheumatol, 2016,35(2):417-425. doi: 10.1007/s10067-014-2817-6. doi: 10.1007/s10067-014-2817-6 URL pmid: 25376466
[8]	边赛男, 刘晓清. γ干扰素释放试验在免疫功能抑制人群中诊断结核分枝杆菌感染的应用. 中华实验和临床感染病杂志(电子版), 2017,11(2):117-120. doi: 10.3877/cma.j.issn.1674-1358.2017.02.003.
[9]	安海转, 贾晓霞, 樊凯, 等. CD8⁺调节性T细胞在疾病中的作用. 中华风湿病学杂志, 2018,22(3):214-216. doi: 10.3760/cma.j.issn.1007-7480.2018.03.017.
[10]	石文卉, 陈维, 荆玮, 等. 肺结核患者淋巴细胞亚群检测结果与临床特征的相关性探讨. 中国防痨杂志, 2017,39(2):140-144. doi: 10.3969/j.issn.1000-6621.2017.02.007.
[11]	Brzustewicz E, Bryl E. The role of cytokines in the pathogenesis of rheumatoid arthritis-Practical and potential application of cytokines as biomarkers and targets of personalized therapy. Cytokine, 2015,76(2):527-536. doi: 10.1016/j.cyto.2015.08.260. doi: 10.1016/j.cyto.2015.08.260 URL pmid: 26321413

组别	例数	性别[例(构成比,%)]		年龄 [岁,M(Q₁,Q₃)]	患者类型[例(构成比,%)]
组别	例数	男	女	年龄 [岁,M(Q₁,Q₃)]	初治	复治
观察组	117例	59(50.43)	58(49.57)	58.00(48.00,66.50)	83(70.94)	34(29.06)
对照组	117例	30(25.64)	87(74.36)	54.00(31.00,68.00)	73(62.39)	44(37.61)
统计检验值		χ²=15.25		Z=1.83	χ²=1.92
P值		0.000		0.068	0.166

检测项目	观察组	对照组	统计检验值	P值
结核抗体(38kD+16kD)[例(构成比,%)]			χ²=25.59	0.000
阳性	8(6.84)	39(33.33)
阴性	109(93.16)	78(66.67)
结核抗体(38kD)[例(构成比,%)]			χ²=59.78	0.000
阳性	25(21.37)	84(71.79)
阴性	92(78.63)	33(28.21)
γ干扰素释放试验[例(构成比,%)]			χ²=0.70	0.792
阳性	67(57.26)	65(55.56)
阴性	50(42.74)	52(44.44)
T淋巴细胞亚群计数[个/μl,M(Q₁,Q₃)]
CD4⁺	513.00(339.75,844.50)	380.00(320.00,503.00)	Z=2.11	0.035
CD8⁺	377.50(193.00,528.50)	475.00(410.00,524.00)	Z=2.27	0.023
CD4⁺/CD8⁺	0.96(0.74,1.53)	0.91(0.74,0.96)	Z=4.90	0.000

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