中华传染病杂志
中華傳染病雜誌
중화전염병잡지
Chinese Journal of Infectious Diseases
2015年
8期
456-459
,共4页
冉燕%李佳%罗亚文%易学东%赵建军
冉燕%李佳%囉亞文%易學東%趙建軍
염연%리가%라아문%역학동%조건군
结核 ,肺%药物性肝损伤%抗结核%T h17/T reg
結覈 ,肺%藥物性肝損傷%抗結覈%T h17/T reg
결핵 ,폐%약물성간손상%항결핵%T h17/T reg
Tuberculosis,pulmonary%Drug-induced liver injury%Antitubercular%Th17/Treg
目的：观察肺结核抗结核化学治疗后药物性肝损伤患者外周血T h17／T reg比率的变化，并探讨其与肝功能的关系。方法选取2013年2月至2015年3月遵义医学院附属医院诊断为继发性肺结核的肝功能正常的住院患者90例，抗结核化学治疗2周后，21例患者ALT 和（或）AST ≥2×正常值上限（ULN），作为伴有肝损伤的肺结核组；其余69例 ALT和（或）AST＜2× ULN ，作为不伴肝损伤的肺结核组。抗结核化学治疗前抽取外周血检测T h17／T reg比率和肝脏生物化学指标，2周后复查，比较两组抗结核化学治疗前后Th17／Treg比率的变化及其与ALT、AST 的相关性。数据采用 t检验，相关性检验采用Pearson相关性分析。结果抗结核化学治疗前，两组间 Th17、Treg及 Th17／Treg比率的差异均无统计学意义（均 P＞0．05）。抗结核化学治疗2周后，伴肝损伤的肺结核组和不伴肝损伤的肺结核组T h17[（2．522±0．388）／m L比（2．075±0．369）／m L ，t＝3．633，P＜0．01；（2．326±0．348）／m L比（1．929±0．402）／mL ，t＝6．468，P＜0．01）]和 Th17／Treg比率（0．618±0．104比0．489±0．107，t＝3．553，P＜0．01；0．554±0．108比0．450±0．098，t＝6．353，P＜0．01）均较治疗前升高，差异有统计学意义，而T reg治疗前后变化不明显（均 P＞0．05）；伴肝损伤的肺结核组 T h17（ t＝2．203，P＜0．05）及Th17／Treg比率（t＝2．345，P＜0．05）均较不伴肝损伤的肺结核组显著升高，差异有统计学意义。Th17／Treg比率与 ALT 呈正相关（r＝0．849，P＝0．044），与 AST 无明显相关性（P＞0．05）。结论 Th17／T reg比率的变化与肺结核抗结核化学治疗后药物性肝损伤有关。
目的：觀察肺結覈抗結覈化學治療後藥物性肝損傷患者外週血T h17／T reg比率的變化，併探討其與肝功能的關繫。方法選取2013年2月至2015年3月遵義醫學院附屬醫院診斷為繼髮性肺結覈的肝功能正常的住院患者90例，抗結覈化學治療2週後，21例患者ALT 和（或）AST ≥2×正常值上限（ULN），作為伴有肝損傷的肺結覈組；其餘69例 ALT和（或）AST＜2× ULN ，作為不伴肝損傷的肺結覈組。抗結覈化學治療前抽取外週血檢測T h17／T reg比率和肝髒生物化學指標，2週後複查，比較兩組抗結覈化學治療前後Th17／Treg比率的變化及其與ALT、AST 的相關性。數據採用 t檢驗，相關性檢驗採用Pearson相關性分析。結果抗結覈化學治療前，兩組間 Th17、Treg及 Th17／Treg比率的差異均無統計學意義（均 P＞0．05）。抗結覈化學治療2週後，伴肝損傷的肺結覈組和不伴肝損傷的肺結覈組T h17[（2．522±0．388）／m L比（2．075±0．369）／m L ，t＝3．633，P＜0．01；（2．326±0．348）／m L比（1．929±0．402）／mL ，t＝6．468，P＜0．01）]和 Th17／Treg比率（0．618±0．104比0．489±0．107，t＝3．553，P＜0．01；0．554±0．108比0．450±0．098，t＝6．353，P＜0．01）均較治療前升高，差異有統計學意義，而T reg治療前後變化不明顯（均 P＞0．05）；伴肝損傷的肺結覈組 T h17（ t＝2．203，P＜0．05）及Th17／Treg比率（t＝2．345，P＜0．05）均較不伴肝損傷的肺結覈組顯著升高，差異有統計學意義。Th17／Treg比率與 ALT 呈正相關（r＝0．849，P＝0．044），與 AST 無明顯相關性（P＞0．05）。結論 Th17／T reg比率的變化與肺結覈抗結覈化學治療後藥物性肝損傷有關。
목적：관찰폐결핵항결핵화학치료후약물성간손상환자외주혈T h17／T reg비솔적변화，병탐토기여간공능적관계。방법선취2013년2월지2015년3월준의의학원부속의원진단위계발성폐결핵적간공능정상적주원환자90례，항결핵화학치료2주후，21례환자ALT 화（혹）AST ≥2×정상치상한（ULN），작위반유간손상적폐결핵조；기여69례 ALT화（혹）AST＜2× ULN ，작위불반간손상적폐결핵조。항결핵화학치료전추취외주혈검측T h17／T reg비솔화간장생물화학지표，2주후복사，비교량조항결핵화학치료전후Th17／Treg비솔적변화급기여ALT、AST 적상관성。수거채용 t검험，상관성검험채용Pearson상관성분석。결과항결핵화학치료전，량조간 Th17、Treg급 Th17／Treg비솔적차이균무통계학의의（균 P＞0．05）。항결핵화학치료2주후，반간손상적폐결핵조화불반간손상적폐결핵조T h17[（2．522±0．388）／m L비（2．075±0．369）／m L ，t＝3．633，P＜0．01；（2．326±0．348）／m L비（1．929±0．402）／mL ，t＝6．468，P＜0．01）]화 Th17／Treg비솔（0．618±0．104비0．489±0．107，t＝3．553，P＜0．01；0．554±0．108비0．450±0．098，t＝6．353，P＜0．01）균교치료전승고，차이유통계학의의，이T reg치료전후변화불명현（균 P＞0．05）；반간손상적폐결핵조 T h17（ t＝2．203，P＜0．05）급Th17／Treg비솔（t＝2．345，P＜0．05）균교불반간손상적폐결핵조현저승고，차이유통계학의의。Th17／Treg비솔여 ALT 정정상관（r＝0．849，P＝0．044），여 AST 무명현상관성（P＞0．05）。결론 Th17／T reg비솔적변화여폐결핵항결핵화학치료후약물성간손상유관。
Objective To observe the changes of the peripheral blood T helper (Th)17 cells/regulatory T cells (Treg) ratio in patients with anti‐tuberculosis drug‐induced liver injury ,and to explore the relationship between Th17/Treg ratio and liver function . Methods Ninety inpatients with the diagnosis of secondary pulmonary tuberculosis (TB) from Affiliated Hospital of Zunyi Medical College from Feb .2013 to Mar .2015 were included in this study .All these patients had normal base line liver function .After 2 weeks of anti‐TB chemotherapy ,21 patients with alanine transaminase (ALT) and/or aspartate aminotransferase (AST) ≥2 × upper limit of normal (ULN) were defined as TB with liver injure group ,the other 69 patients with ALT and/or AST<2 × ULN were defined as TB with non‐liver injured group .Before treatment and two weeks after anti‐TB therapy ,the peripheral blood Th17/Treg ratios and liver functions of all patients in both groups were detected in order to compare the changes of Th17/Treg ratios pre and post anti‐TB chemotherapy and to explore the relationship between Th17/Treg ratio and ALT/AST levels .Student′s t test was used for statistical analysis ,and Pearson correlation analysis was used for correlation test .Results Before treatment ,there was no statistical significance of Th17 ,Treg and Th17/Treg ratio between groups (P> 0 .05) .The Th17 levels in TB with liver injured group ([2 .522 ± 0 .388]/mL vs [2 .075 ± 0 .369]/mL ,t=3 .633 ,P<0 .01) and TB with non‐liver injured group ([2 .326 ± 0 .348]/mL vs [1 .929 ± 0 .402]/mL ,t= 6 .468 , P< 0 .01) ,and Th17/Treg ratios in both groups(0.618±0.104vs0.489±0.107,t=3.553,P<0.01 ;0.554±0.108vs0.450±0.098,t=6 .353 ,P<0 .01) were all increased after anti‐TB chemotherapy ,with statistically significant differences . However ,there was no statistical significance of Treg levels pre and post anti‐treatment in both groups (both P>0 .05) .The Th17 level and Th17/Treg ratio in TB with liver injured group were significantly higher than those in TB with non‐liver injured group (t= 2 .203 , P< 0 .05 and t= 2 .345 , P< 0 .05 , respectively) .In liver injured group ,the Th17/Treg ratio was positively correlated with ALT level (r=0 .849 ,P=0 .044) ,but not with AST level (P>0 .05) .Conclusion The changes of Th17/Treg ratio are related with anti‐TB drug‐induced liver injury in patients with secondary pulmonary tuberculosis .
