肺结核及并发肺外结核患者淋巴细胞亚群变化的研究及其临床意义

doi:10.19983/j.issn.2096-8493.2024042

摘要/Abstract

摘要：

目的：探讨肺结核及并发肺外结核患者淋巴细胞亚群的变化及其临床意义。方法：收集2019年1月1日至2023年1月1日在福建省福州肺科医院确诊的256例肺结核及75例肺结核并发肺外结核患者,对比肺结核与肺外结核组及其各亚组间外周血中淋巴细胞亚群绝对计数以判断其临床价值。结果：肺结核组患者CD3⁺T淋巴细胞[902.50(608.25,1269.75)]、CD4⁺T淋巴细胞[539.00(357.75,765.50)]、CD8⁺T淋巴细胞[337.50(209.00,472.00)]、B细胞[159.00(82.00,257.50)]、NK细胞[160.00(88.50,244.50)]的数量均显著高于肺结核并发肺外结核组[729.50(468.25,975.50)]、[378.00(171.50,562.00)]、[276.00(152.00,412.00)]、[84.00(57.75,167.75)]、[128.00(51.00,192.00)],差异有统计学意义(Z=-3.074,P=0.002;Z=-4.488,P<0.0001;Z=-8.283,P=0.0341;Z=-2.954,P=0.003;Z=-2.115,P=0.034)。继发性肺结核组与其他亚组相比,CD3⁺T淋巴细胞的数量[995.00(668.25,1409.75)]显著高于血行播散性肺结核组[709.50(391.00,975.00](Z=2.829,P=0.014)和继发性肺结核并发结核性胸膜炎组[764.00(527.25,1075.00)](Z=3.215,P=0.004)、继发性肺结核并发结核性脑膜炎[778.00(537.50,976.00)](Z=2.915,P=0.011)、继发性肺结核并发多种肺外结核[642.00(244.25,830.50)](Z=2.994,P=0.008)。CD4⁺T淋巴细胞数量[604.00(384.50,853.00)]显著高于继发性肺结核并发结核性胸膜炎[485.00(309.00,641.00)](Z=2.684,P=0.022)、继发性肺结核并发结核性脑膜炎[378.00(181.50,571.50)](Z=3.780,P=0.0005)、继发性肺结核并发多种肺外结核[277.50(98.00,469.00)](Z=3.445,P=0.002)。CD8⁺T淋巴细胞数量[382.50(227.75,496.25)]显著高于继发性肺结核并发结核性胸膜炎[273.00(170.25,406.25)](Z=2.995,P=0.008)。B细胞的数量[177.00(94.00,287.00)]显著高于血行播散性肺结核组[104.50(74.00,138.00)](Z=2.700,P=0.021)、继发性肺结核并发结核性胸膜炎组[132.00(66.00,200.00)](Z=2.761,P=0.017)、继发性肺结核并发多种肺外结核[75.00(55.50,115.75)](Z=3.038,P=0.007)。NK细胞的数量[177.00(103.75,264.00)]显著高于血行播散性肺结核组[128.50(48.00,175.75)](Z=2.822,P=0.014)、继发性肺结核并发结核性胸膜炎组[127.00(72.00,245.00)](Z=3.078,P=0.006)。结论：继发性肺结核并发其他类型肺结核或肺外结核时表现出比单纯继发性肺结核更低的CD3⁺T、CD4⁺T淋巴细胞、B细胞和NK细胞数量,反映了一种相对抑制的免疫状态。

关键词: 结核,肺, 免疫, 细胞, 淋巴细胞亚群

Abstract:

Objective: This study aimed to investigate the alterations in peripheral blood lymphocyte subsets during the dissemination of secondary pulmonary tuberculosis and their clinical implications. Methods: Data were collected from 256 patients diagnosed with pulmonary tuberculosis and 75 with concurrent extrapulmonary tuberculosis between January 1, 2019, and January 1, 2023, at Fuzhou Pulmonary Hospital in Fujian Province. The absolute counts of peripheral blood lymphocyte subsets were compared between the pulmonary and extrapulmonary tuberculosis groups and among their respective subgroups to assess their clinical value. Results: Significantly higher amount of CD3⁺ T cells (902.50 (608.25,1269.75)), CD4⁺ T cells (539.00 (357.75,765.50)), CD8⁺ T cells (337.50 (209.00,472.00)), B cells (159.00 (82.00,257.50)), and NK cells (160.00 (88.50,244.50)) were observed in the pulmonary tuberculosis group compared to pulmonary tuberculosis combined with extrapulmonary tuberculosis group (729.50 (468.25,975.50))、(378.00 (171.50,562.00))、(276.00 (152.00,412.00))、(84.00 (57.75,167.75))、(128.00 (51.00,192.00))(Z=-3.074,P=0.002;Z=-4.488,P<0.0001;Z=-8.283,P=0.034;Z=-2.954,P=0.003;Z=-2.115,P=0.03). The comparison between different subgroups show that: secondary pulmonary tuberculosis had significantly higher counts of CD3⁺ T cells (995.00 (668.25,1409.75)) than hematogenous disseminated pulmonary tuberculosis (709.50 (391.00,975.00)(Z=2.829,P=0.014), secondary pulmonary tuberculosis combined with tuberculous pleurisy (764.00 (527.25,1075.00))(Z=3.215,P=0.004), secondary pulmonary tuberculosis combined with tuberculous meningitis (778.00 (537.50,976.00))(Z=2.915,P=0.011), and secondary pulmonary tuberculosis combined with multiple extrapulmonary tuberculosis (642.00 (244.25,830.50))(Z=2.994,P=0.008). The number of CD4⁺ T cells (604.00 (384.50,853.00)) from secondary pulmonary tuberculosis was significantly higher than secondary pulmonary tuberculosis combined with tuberculous pleurisy (485.00 (309.00,641.00))(Z=2.684,P=0.022), tuberculous meningitis (378.00 (181.50,571.50))(Z=3.780,P=0.0005), and multiple extrapulmonary tuberculosis (277.50 (98.00,469.00))(Z=3.445,P=0.002). The count of CD8⁺ T cells (382.50 (227.75,496.25)) from secondary pulmonary tuberculosis was significantly higher than secondary pulmonary tuberculosis combined with tuberculous pleurisy (273.00 (170.25,406.25))(Z=2.995,P=0.008). The number of B cells (177.00 (94.00,287.00)) from secondary pulmonary tuberculosis was significantly higher than hematogenous disseminated pulmonary tuberculosis (104.50 (74.00,138.00))(Z=2.700,P=0.021), secondary pulmonary tuberculosis combined with tuberculous pleurisy (132.00 (66.00,200.00))(Z=2.761,P=0.017), and secondary pulmonary tuberculosis combined with multiple extrapulmonary tuberculosis (75.00 (55.50,115.75))(Z=3.038,P=0.007). The count of NK cells (177.00 (103.75,264.00)) from secondary pulmonary tuberculosis was significantly higher than hematogenous disseminated pulmonary tuberculosis (128.50 (48.00,175.75))(Z=2.822,P=0.014) and secondary pulmonary tuberculosis combined with tuberculous pleurisy (127.00 (72.00,245.00))(Z=3.078,P=0.006). Conclusion: When secondary pulmonary tuberculosis is accompanied by other forms of the disease or extrapulmonary tuberculosis, it exhibits lower counts of CD3⁺ T cells, CD4⁺ T cells, B cells, and NK cells compared to cases of secondary pulmonary tuberculosis alone, reflecting a relatively suppressed immune state.

Key words: Tuberculosis, pulmonary, Immunity, cellular, Lymphocyte subsets

中图分类号:

陈燕玲, 吴迪, 陈秀平, 林宇君, 陈晓红. 肺结核及并发肺外结核患者淋巴细胞亚群变化的研究及其临床意义[J]. 结核与肺部疾病杂志, 2024, 5(4): 294-304. doi: 10.19983/j.issn.2096-8493.2024042

Chen Yanling, Wu Di, Chen Xiuping, Lin Yujun, Chen Xiaohong. Study on the changes in lymphocyte subsets during secondary pulmonary tuberculosis dissemination and its clinical significance[J]. Journal of Tuberculosis and Lung Disease, 2024, 5(4): 294-304. doi: 10.19983/j.issn.2096-8493.2024042

图/表 8

表1

表2

表3

继发性肺结核并发肺外结核组患者的临床特征

临床特征	并发结核性脑膜炎组(31例)	并发骨关节结核组(31例)	并发多种肺外结核组(13例)	统计检验值	P值
年龄[岁, $x ˉ$ ±s]	52.35±15.06	52.94±16.97	49.62±12.41	H=0.216	0.806
性别[例,构成比(%)]				χ²=10.236	0.006
女性	14(45.16)	4(12.90)	7(53.85)
男性	17(54.84)	27(87.10)	6(46.15)
治疗分类[例,构成比(%)]				-^a	0.209
初治	31(100.00)	28(90.32)	13(100.00)
复治	0(0.00)	3(9.68)	0(0.00)

表3

表4

表5

图1~10

图11~20

图21~30

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临床特征	肺结核组 (256例)	肺结核并发肺外结核组(75例)	统计检验值	P值
年龄[岁,M(Q₁,Q₃)]	56.00(44.00,67.00)	53.00(40.00,64.00)	Z=1.115	0.265
性别[例,构成比(%)]			χ²=1.161	0.281
女性	69(26.95)	25(33.33)
男性	187(73.05)	50(66.67)
治疗分类[例,构成比(%)]			χ²=1.753	0.185
初治	234(91.41)	72(96.00)
复治	22(8.59)	3(4.00)

临床特征	血行播散性肺结核组(16例)	继发性肺结核组 (160例)	继发性肺结核并发结核性胸膜炎组(80例)	统计检验值	P值
年龄[岁,M(Q₁,Q₃)]	46.50(31.00,60.50)	56.00(46.00,67.30)	57.00(35.75,67.25)	H=4.608	0.100
性别[例,构成比(%)]				χ²=21.789	<0.001
女性	10(62.50)	50(31.25)	9(11.25)
男性	6(37.50)	110(68.75)	71(88.75)
治疗分类[例,构成比(%)]				χ²=0.119	0.942
初治	15(93.75)	146(91.25)	73(91.25)
复治	1(6.25)	14(8.75)	7(8.75)

	CD3⁺T细胞 [个/μl,M(Q₁,Q₃)]	CD4⁺T细胞 [个/μl,M(Q₁,Q₃)]	CD8⁺T细胞 [个/μl,M(Q₁,Q₃)]	B细胞[个/ul, M(Q₁,Q₃)]	NK细胞[个/ul, M(Q₁,Q₃)]	CD4⁺T/CD8⁺T 比值M(Q₁,Q₃)
肺结核组	902.50(608.25, 1269.75)	539.00(375.75, 765.00)	337.50(209.00, 472.00)	159.00(82.00, 257.50)	160.00(88.50, 244.50)	1.62(1.15, 2.27)
肺外结核组	729.50(468.25, 975.50)	378.00(171.50, 562.00)	276.00(152.06, 412.00)	84.00(57.75, 167.75)	128.00(51.00, 192.00)	1.31(0.88, 2.37)
SPT	995.00(668.25, 1409.75)	604.00(384.50, 853.00)	382.50(227.75, 496.25)	177.00(94.00, 287.00)	177.00(103.75, 264.00)	1.66(1.15, 2.28)
SPT+TBM	778.00(537.50, 976.00)	378.00(181.50, 571.50)	306.50(190.25, 434.25)	115.00(58.50, 253.50)	122.50(56.75, 207.00)	1.37(0.88, 2.12)
SPT+TBP	764.00(527.25, 1075.00)	485.00(309.00, 641.00)	273.00(170.25, 406.25)	132.00(66.00, 200.00)	127.00(72.00, 245.00)	1.53(1.16, 2.16)
SPT+BJTB	735.00(462.50, 1007.00)	402.00(222.50, 561.75)	210.00(170.50, 391.00)	89.00(61.50, 131.50)	149.00(57.00, 195.50)	1.77(1.14, 2.79)
HDPT	709.50(391.00, 975.00)	439.00(254.00, 607.00)	283.50(185.25, 416.75)	104.50(74.00, 138.00)	128.50(48.00, 175.75)	1.63(1.26, 2.41)
SPT+MEPTB	642.00(244.25, 830.50)	277.50(98.00, 469.00)	281.50(87.25, 405.75)	75.00(55.50, 115.75)	107.50(45.50, 191.25)	1.08(0.65, 2.52)

	IL-6浓度 [pg/ml,M(Q₁,Q₃)]	EOS计数 [10⁹/L,M(Q₁,Q₃)]	补体C3浓度 [g/L,M(Q₁,Q₃)]	补体C4浓度 [g/L,M(Q₁,Q₃)]
肺结核组	18.16(5.38,41.92)	0.09(0.03,0.18)	1.25(1.04,1.41)	0.36(0.24,0.37)
肺外结核组	26.20(12.57,59.20)	0.08(0.04,0.21)	1.24(1.04,1.40)	0.34(0.26,0.39)
SPT	12.94(3.91,39.94)	0.11(0.06,0.18)	1.21(1.02,1.39)	0.30(0.24,0.37)
SPT+TBM	21.27(10.02,59.16)	0.12(0.05,0.23)	1.17(1.02,1.30)	0.33(0.27,0.38)
SPT+TBP	23.35(13.05,42.36)	0.10(0.03,0.23)	1.30(1.16,1.51)	0.32(0.27,0.39)
SPT+BJTB	33.60(5.93,106.40)	0.11(0.03,0.21)	1.35(1.06,1.49)	0.35(0.24,0.39)
HDPT	35.34(15.33,97.42)	0.02(0.00,0.06)	1.18(1.00,1.35)	0.27(0.23,0.36)
SPT+MEPTB	36.42(19.97,63.49)	0.08(0.05,0.27)	1.24(1.03,1.33)	0.32(0.22,0.42)