本文選題：耐多藥結核 + 細胞免疫功能�。� 參考：《實用預防醫(yī)學》2016年10期

【摘要】：目的動態(tài)觀察耐多藥結核病患者機體細胞免疫狀態(tài),為臨床診治用藥提供支持,為以后耐多藥結核病的免疫治療打下初步基礎。方法用絕對濃度法進行藥敏試驗,篩選出耐多藥結核(Multi-drug resistant tuberculosis,MDRTB)患者50例,藥物敏感性結核(drug-susceptible tuberculosis,S-TB)患者50例,另于體檢者中選取健康對照(healthy control,HC)20例,流式細胞分析淋巴細胞亞群(CD4~+、CD3~+、CD8~+分子等),酶聯(lián)免疫吸附法(enzyme-linked immunosorbent assay,ELISA)檢測血清細胞因子(IFN-γ、IL-2、IL-4和IL-10等),比較耐多藥結核病患者血清學與全敏結核病患者血清、正常人血清之間的差異。結果各組間CD3~+分子百分比差異無統(tǒng)計學意義,健康組與各結核組CD4+、CD8~+、CD4~+/CD8~+百分比差異有統(tǒng)計學意義,耐多藥結核組與結核敏感組CD4~+、CD8~+、CD4~+/CD8~+百分比差異有統(tǒng)計學意義。健康組與各結核組IFN-γ、IL-2、IL-4和IL-10的濃度差異均有統(tǒng)計學意義,耐多藥結核組與結核敏感組IL-2、IL-4和IL-10的濃度差異有統(tǒng)計學意義。耐多藥結核組CD4~+、CD4~+/CD8~+比值、IL-2顯著低于結核敏感組,CD8~+、IL-4和IL-10顯著高于結核敏感組(P0.05)。結論結核病患者細胞免疫功能均下降,表現(xiàn)為CD4~+淋巴細胞百分比降低,CD8~+淋巴細胞百分比升高,CD4~+/CD8~+比值降低甚至倒置,增強抗結核免疫反應的細胞因子IFN-γ、IL-2濃度降低而抑制此反應的細胞因子IL-4和IL-10濃度升高。耐多藥結核病患者較敏感結核病患者的細胞免疫功能進一步下降,表現(xiàn)為上述變化更加顯著,使病情表現(xiàn)更加復雜及增加了治療難度。
[Abstract]:Objective to observe the cellular immune status of MDR-TB patients dynamically, to provide support for clinical diagnosis and treatment of MDR-TB, and to lay a preliminary foundation for the immunotherapy of MDR-TB in the future. Methods 50 patients with multi-drug resistant tuberculosism MDRTB, 50 patients with drug-sensitive tuberculosis tuberculiasis S-TBand 20 healthy control patients were selected by absolute concentration test. Lymphocyte subsets CD4 ~ + CD3 ~ + CD8 ~ + were analyzed by flow cytometry and enzyme linked immunosorbent assaysis-ELISA-linked enzyme linked immunosorbent assay (Elisa) was used to detect serum cytokines, such as IFN- 緯, IL-2IL-4 and IL-10, and to compare the difference between the serum of MDR-TB patients and the sera of the patients with MDR-TB and the healthy people. Results there was no significant difference in the percentage of CD3- molecule between each group, but there was significant difference between the healthy group and the tuberculosis group in the percentage of CD4 CD8 ~ / / CD8 ~%, while there was a significant difference in the percentage of CD4 ~ + CD8 ~-/ -CD8 ~ ~ between the MDR-TB group and the TB sensitive group. The concentrations of IL-4 and IL-10 were significantly different between the healthy group and the tuberculosis group, and the concentrations of IL-4 and IL-10 were significantly different between the multi-drug resistant tuberculosis group and the tuberculosis sensitive group. In MDR-TB group, the ratio of CD4 ~ / CD4 ~ / CD8 ~ ~ + was significantly lower than that in susceptible TB group (P 0.05), and the levels of CD8 ~ + IL-4 and IL-10 in MDR-TB group were significantly higher than those in TB sensitive group (P < 0.05). Conclusion the cellular immune function of tuberculosis patients is decreased, the percentage of CD4 ~ lymphocytes is decreased and the percentage of CD8 ~ lymphocytes is increased. The ratio of CD4 ~ / / CD8 ~ ~ is decreased or even inverted. The concentration of IFN- 緯 -IL-2, a cytokine that enhanced the anti-tuberculosis immune response, decreased, while the concentration of cytokines IL-4 and IL-10, which inhibited the response, increased. The cellular immune function of the more sensitive TB patients with MDR-TB decreased further, which showed that the above changes were more significant, which made the disease more complex and more difficult to treat.
【作者單位】： 長沙市中心醫(yī)院檢驗科;
【基金】：十二五重大專項課題項目(2013ZX10005004-004)
【分類號】：R52

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