摘要
目的探讨肺结核合并慢性阻塞性肺病(慢阻肺)患者免疫功能的变化及其意义。方法对2008年1月至2011年1月在同济大学附属肺科医院住院的118例肺结核合并慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)患者(研究组)免疫功能进行检测,并与120例肺结核患者(肺结核对照组)和110名正常健康人群(健康对照组)进行对比分析。采用流式细胞仪抗体双标法检测外周血CD3-CD16+CD56+NK细胞,T淋巴细胞亚群(CD4、CD8、CD4/CD8)的表达率,采用免疫比浊法检测患者血清IgM、IgG、IgA含量,采用双抗体夹心ABC-ELISA法测定患者血清中sIL-2R、TNF-α、IL-6、IFN-γ的水平。结果研究组、肺结核对照组的CD4、CD4/CD8和NK细胞表达率均明显低于健康对照组(P<0.01),而研究组CD8%明显高于健康对照组(P<0.001)。研究组CD4%、CD4/CD8低于肺结核对照组(P<0.001),CD8%高于肺结核对照组(P<0.01)。研究组IgG、,IgA、IgM水平低于健康对照组(P<0.05);而肺结核对照组与健康对照组IgG、IgM水平差异无统计学意义(P>0.05),仅IgA水平低于健康对照组(P<0.05);研究组与肺结核对照组IgG、IgA水平差异无统计学意义(P>0.05),研究组IgM水平低于肺结核对照组(P=0.007)。研究组、肺结核对照组sIL-2R、TNF-α、IL-6、IFN-γ水平均高于健康对照组(P<0.05)。研究组sIL-2R、IFN-γ高于肺结核对照组(P<0.05),但研究组及肺结核对照组之间TNF-α水平、IL-6水平差异无统计学意义(P>0.05)。结论肺结核患者主要是细胞免疫受损,但体液免疫受损也在其中起到一定的作用;而肺结核合并慢性阻塞性肺病患者的细胞免疫和体液免疫功能均有低下,免疫功能受损程度较单纯肺结核患者更为严重。
Objective To investigate the changes of immune function in patients with lung tubercu- losis complicated by chronic obstructive pulmonary disease （COPD）. Methods One hundred and eighteen patients of lung tuberculosis complicated with COPD （study group） and 120 patients with lung tuberculosis（TB control group）admitted to hospital in January 2008 to January 2011 were enrolled in the study; 110 healthy subjects served as normal controls. The NK cells and T lymphocyte subsets in peripheral whole blood samples were detected by flow cytometry. The levels of IgM, IgG, and IgA were measured by immunoturbidimetry. The levels of slL-2R, TNF-α, IL-6 and IFN-γwere measured with sandwich ABC-ELISA method. Results The percentages of NK cells, CD4 and CD4/CD8 ratio in study group and in TB control group were lower than those in normal control group（ P 〈 0.01 ）. The levels of CD8 in study group were higher than those in normal control group（P 〈0.001 ）. The levels of CD4 and CD4/CD8 ratio in study group were lower than those in TB control group（ P 〈 0.001 ）. The levels of IgM, IgG and IgA in study group were lower than those in normal control group （ P 〈 0.05 ）. There were no significant differences between study group and TB control group in the levels of IgG and IgA （ P 〉 0.05 ）. There were no significant differences between TB control group and normal control group in levels of IgG and IgM（P 〉0.05）. The levels of sIL-2R, TNF-α, IL-6 and IFN-γ in study group and in the TB control group were higher than those in healthy subjects （ P 〈 0.05 ）. The levels of sIL-2R and IFN-γin study group were higher than those in TB control group （ P 〈 0.05 ）. There were no significant differences between study group and TB control grou in level of TNF-α and IL-6. Conclusion The results reveal that both cellular immunity and humoral immunity are impaired in patients with lung tuberculosis complicated by COPD, the impairment is more severe than that in patients with simple lung tuberculosis.
出处
《同济大学学报（医学版）》
CAS
2012年第1期53-58,共6页
Journal of Tongji University(Medical Science)
基金
国家十一五重大专项课题"特大城市结核病综合防治模式研究"(2009ZX10003-017)
关键词
肺结核
慢性阻塞性肺疾病
天然杀伤细胞
T淋巴细胞
免疫球蛋白
细胞因子
pulmonary tuberculosis
pulmonary disease
chronic obstructive
killer cells
natural
T lymphocytes
immunoglobulins
cytokines
