【摘要】 目的探讨活动性肺结核患者外周血γ-干扰素释放分析T-SPOT.TB测定与不同痰结核菌分级及肺部病变程度的关系。方法采用T-SPOT.TB技术、根据斑点形成细胞数(SFCs)检测77例初治活动性肺结核患者、14例肺部非结核病变者和12例健康对照者外周血结核抗原特异性的IFN-γ分泌细胞数,结合痰细菌学和影像学检查进行分析。结果肺结核组T-SPOT.TB的6KD早期分泌抗原靶点抗原孔(A孔)SFCs为55.00(21.00~102.50),10KD培养滤过蛋白抗原孔(B孔)SFCs为65.00(20.50~152.50)。显著高于非肺结核组和健康对照组(P<0.05)。肺结核痰菌分级4+组A孔SFCs为17.00(4.00~31.50),显著低于痰菌阴性组的82.50(36.25~103.75)、1~9条组的65.00(28.50~102.50)、1+组的80.00(32.75~126.25)、2+组的90.00(27.50~145.00)和3+组的45.00(18.00~150.00)(U=41.5,17.0,22.5,26.5,30.5;Z=-2 745,-2.980,-3.325,-2.975,-2.377;均P<0.05);痰菌分级4+组B孔SFCs为21.00(2.50~42.50),显著低于痰菌阴性组的85.00(9.00~195.00)、1~9条组的102.50(71.25~193.75)、1+组的92.50(33.25~165.00)、2+组的70.00(34.00~162.50)和3+组的60.00(20.00~140.00),(U=55.0,10.0,28.5,28.5,36.5;Z=-2.150,-3.413,-3.304,-2.874,-2.031;均P<0.05)。A孔和B孔SFCs在不同病变范围的肺结核患者之间比较差异有统计学意义(F=7.463,3.205;P<0.05),病变范围重度组A孔SFCs为(31.95±51.09),低于轻度组的(99.22±69.09)和中度组(72.43±49.31)(t=3.520,2.845;均P<0.05);病变范围重度组B孔SFCs为(49.42±87.73),低于轻度组(112.39±75.20)和中度组(104.00±94.30)(t=2.505,2.080;均P<0.05)。肺结核空洞组和无空洞组比较,A孔和B孔SFCs均差异无统计学意义(P>0.05)。结论过高的痰结核菌负荷抑制肺结核患者外周血特异性T细胞的IFN-γ释放反应,抑制肺结核患者的保护性免疫;肺结核患者外周血IFN-γ分泌细胞数越少,肺部病变程度的越重,但与肺结核空洞形成无关系。更多还原

【Abstract】 Objective To determine the relationship between the interferon-y release assays measured by T-SPOT.TB in peripheral blood and mycobacterium tuberculosis smear grading and radiographic extent of disease in patients with active pulmonary tuberculosis.Methods T-SPOT.TB assay was used to determine spot-forming cells(SFCs) formed by T-cell which release interferon-γ when stimulated by Mycobacterium tuberculosis-specific antigens in 77 patients with active tuberculosis,14 case controls with non-tuberculosis lung diseases and 12 healthy controls,then the SFCs were compaired with bacteriological and radiographic presentations in new cases of pulmonary tuberculosis.Results The SFCs of A hole in response to ESAT-6and B hole in response to CFP-10 in pulmonary tuberculosis group were 55.00(21.00~102.50) and 65.00(20.50~152.50),respectively,which were all significantly higher than those in controls(P<0.05).The SFCs of A hole and B hole in pulmonary tuberculosis patients with mycobacterium tuberculosis grade of 4+ were 17.00(4.00~31.50)and 21.00(2.50~42.50),respectively.The SFCs of A hole in pulmonary tuberculosis patients with mycobacterium tuberculosis grade of negative,1-9institias,1+,2+ and 3+ were82.50(36.25~103.75),65.00(28.50~102.50),80(32.75~126.25),90.00(27.50~145.00) and 45.00(18.00~150.00),and the SFCs of B hole were 85.00(9.00~195.00),102.50(71.25~193.75),92.50(33.25~165.00),70.00(34.00~162.50) and 60.00(20.00~140.00),respectively.The SFCs of A hole in pulmonary tuberculosis patients with mycobacterium tuberculosis grade of 4+ were significantly higher than thoses in patients with grade of negative,1-9 institias,1+,2+ and 3+(U=41.5,17.0,22.5,26.5,30.5;Z=-2.745,-2.980,-3.325,-2.975,-2.377;P<0.05),so as the SFCs of B hole(U=55.0,10.0,28.5,28.5,36.5;Z=-2.150,-3.413,-3.304,-2.874,-2.031;P<0.05).There were statistical significance about the SFCs of A hole and B hole compared with different extent of disease(F=7.463,3.205;P<0.05).The SFCs of A hole in patients with advance disease,minimal disease and moderate disease were(31.95±51.09),(99.22±69.09) and(72.43±49.31),and the SFCs of B hole were(49.42±87.73),(112.39±75.20) and(104.00±94.30),respectively.The SFCs of A hole in patients with advance disease were significantly lower than minimal disease and moderate disease(t=3.520,2.845;P<0.05),so as the SFCs of B hole(t=2.505,2.080;P<0.05).There were no statistical significance about the SFCs of A hole and B hole compared with cavity and no cavity.Conclusion Exorbitant bacterial burden of mycobacterium tuberculosis depressed the interferon-γ release assays formed by tuberculosis-specific T-cell in patient,s peripheral blood,so that may inhibit protective immunity in patients with pulmonary tuberculosis.SFCs formed by T-cell which release interferon-γ in patient,s peripheral blood were decreased with the severity of the extent of disease and found to be lower in advance disease,but had no relationship with cavity of pulmonary tuberculosis.更多还原