浙江医学
浙江醫學
절강의학
ZHEJIANG MEDICAL JOURNAL
2013年
23期
2057-2060,2064
,共5页
陶学芳%王华钧%王建华%李永兴
陶學芳%王華鈞%王建華%李永興
도학방%왕화균%왕건화%리영흥
肺结核%γ-干扰素%T-SPOT. TB细菌学%影像学
肺結覈%γ-榦擾素%T-SPOT. TB細菌學%影像學
폐결핵%γ-간우소%T-SPOT. TB세균학%영상학
Pulmonary tuberculosis%Interferon- γ%T- SPOT.TB,bacteriology%radiology
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。
目的:探討活動性肺結覈患者外週血γ-榦擾素釋放分析T- SPOT.TB測定與不同痰結覈菌分級及肺部病變程度的關繫。方法採用T- SPOT.TB技術、根據斑點形成細胞數(SFCs)檢測77例初治活動性肺結覈患者、14例肺部非結覈病變者和12例健康對照者外週血結覈抗原特異性的IFN-γ分泌細胞數,結閤痰細菌學和影像學檢查進行分析。結果肺結覈組T- SPOT. TB 的6KD早期分泌抗原靶點抗原孔(A孔)SFCs為55.00(21.00~102.50),10KD培養濾過蛋白抗原孔(B孔)SFCs為65.00(20.50~152.50),顯著高于非肺結覈組和健康對照組(P<0.05)。肺結覈痰菌分級4+組A孔SFCs為17.00(4.00~31.50),顯著低于痰菌陰性組的82.50(36.25~103.75)、1~9條組的65.00(28.50~102.50)、1+組的80.00(32.75~126.25)、2+組的90.00(27.50~145.00)和3+組的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);痰菌分級4+組B孔SFCs為21.00(2.50~42.50),顯著低于痰菌陰性組的85.00(9.00~195.00)、1~9條組的102.50(71.25~193.75)、1+組的92.50(33.25~165.00)、2+組的70.00(34.00~162.50)和3+組的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在不同病變範圍的肺結覈患者之間比較差異有統計學意義(F=7.463,3.205;P<0.05),病變範圍重度組A孔SFCs為(31.95±51.09),低于輕度組的(99.22±69.09)和中度組(72.43±49.31),(t=3.520,2.845;均P<0.05);病變範圍重度組B孔SFCs為(49.42±87.73),低于輕度組(112.39±75.20)和中度組(104.00±94.30),(t=2.505,2.080;均P<0.05)。肺結覈空洞組和無空洞組比較,A孔和B孔SFCs均差異無統計學意義(P>0.05)。結論過高的痰結覈菌負荷抑製肺結覈患者外週血特異性T細胞的IFN-γ釋放反應,抑製肺結覈患者的保護性免疫;肺結覈患者外週血IFN-γ分泌細胞數越少,肺部病變程度的越重,但與肺結覈空洞形成無關繫。
목적:탐토활동성폐결핵환자외주혈γ-간우소석방분석T- SPOT.TB측정여불동담결핵균분급급폐부병변정도적관계。방법채용T- SPOT.TB기술、근거반점형성세포수(SFCs)검측77례초치활동성폐결핵환자、14례폐부비결핵병변자화12례건강대조자외주혈결핵항원특이성적IFN-γ분비세포수,결합담세균학화영상학검사진행분석。결과폐결핵조T- SPOT. TB 적6KD조기분비항원파점항원공(A공)SFCs위55.00(21.00~102.50),10KD배양려과단백항원공(B공)SFCs위65.00(20.50~152.50),현저고우비폐결핵조화건강대조조(P<0.05)。폐결핵담균분급4+조A공SFCs위17.00(4.00~31.50),현저저우담균음성조적82.50(36.25~103.75)、1~9조조적65.00(28.50~102.50)、1+조적80.00(32.75~126.25)、2+조적90.00(27.50~145.00)화3+조적45.00(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;균P<0.05);담균분급4+조B공SFCs위21.00(2.50~42.50),현저저우담균음성조적85.00(9.00~195.00)、1~9조조적102.50(71.25~193.75)、1+조적92.50(33.25~165.00)、2+조적70.00(34.00~162.50)화3+조적60.00(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;균P<0.05)。A공화B공SFCs재불동병변범위적폐결핵환자지간비교차이유통계학의의(F=7.463,3.205;P<0.05),병변범위중도조A공SFCs위(31.95±51.09),저우경도조적(99.22±69.09)화중도조(72.43±49.31),(t=3.520,2.845;균P<0.05);병변범위중도조B공SFCs위(49.42±87.73),저우경도조(112.39±75.20)화중도조(104.00±94.30),(t=2.505,2.080;균P<0.05)。폐결핵공동조화무공동조비교,A공화B공SFCs균차이무통계학의의(P>0.05)。결론과고적담결핵균부하억제폐결핵환자외주혈특이성T세포적IFN-γ석방반응,억제폐결핵환자적보호성면역;폐결핵환자외주혈IFN-γ분비세포수월소,폐부병변정도적월중,단여폐결핵공동형성무관계。
Objective To determine the relationship between the interferon- γ 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- cellwhich 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- 6 and 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),re-spectively,which were al significantly higher than those in controls (P<0.05). The SFCs of A hole and B hole in pulmonary tuber-culosis 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+ were 82.50 (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 Ex-orbitant bacterial burden of mycobacterium tuberculosis depressed the interferon- γ release assays formed by tuberculo-sis- specific T- cellin patient,s peripheral blood,so that may inhibit protective immunity in patients with pulmonary tuberculosis. SFCs formed by T- cellwhich release interferon- γin 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.