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目的通过检测结核性胸膜炎患者抗结核治疗前后胸水和外周血中γδT细胞和Th17细胞的比例,探讨2群细胞在该病的发生及治疗过程中的变化及意义。方法选取结核性胸膜炎患者30例,分别采集患者抗结核治疗前和治疗后(7～10 d)的胸水及外周血,分离单个核细胞,采用流式细胞术检测γδT和Th17细胞的比例,同时设立健康对照组。结果与健康对照组相比,抗结核治疗前结核性胸膜炎患者外周血中CD3+T细胞比例显著降低(P<0.05),而γδT细胞的比例显著升高(P<0.05),表达IFN-γ的CD3+T和γδT细胞比例均显著升高(P<0.01);患者胸水中的CD3+T和γδT细胞比例显著高于患者外周血(P<0.05),胞内IFN-γ水平与2群细胞变化一致。抗结核治疗后患者外周血和胸水中CD3+T细胞比例较治疗前升高而γδT细胞比例下降,胞内IFN-γ的水平较治疗前显著降低(P<0.05)。抗结核治疗前结核性胸膜炎患者外周血中CD4+T细胞比例较健康对照组显著降低(P<0.01)而Th17细胞比例显著升高(P<0.01);患者胸水中CD4+T细胞显著高于外周血(P<0.05)而Th17细胞比例显著降低(P<0.05)。抗结核治疗后患者胸水中CD4+T和Th17细胞比例较治疗前升高但无显著性差异;IL-17+T与Th17细胞之间无显著相关性,而CD4+RORγt+T与Th17细胞之间存在显著相关性(r=0.564,P<0.05)。结论γδT和Th17细胞在抗结核治疗前后具有显著差异提示2群细胞可能在结核性胸膜炎的发病和治疗中发挥重要作用。
Objective To detect the changes and significance of two groups of cells in the occurrence and treatment of the disease by detecting the ratio of γδT cells and Th17 cells in pleural effusion and peripheral blood before and after antituberculous therapy in patients with tuberculous pleurisy. Methods Thirty patients with tuberculous pleurisy were selected. The pleural effusion and peripheral blood were collected before and after antituberculous treatment (7 ~ 10 days), and the mononuclear cells were isolated. The proportion of γδT and Th17 cells was detected by flow cytometry Set up a healthy control group. Results Compared with the healthy control group, the percentage of CD3 + T cells in peripheral blood of patients with tuberculous pleurisy before antituberculous treatment was significantly lower (P <0.05), while the proportion of γδT cells was significantly increased (P <0.05) (P <0.01). The proportion of CD3 + T and γδT cells in pleural effusion was significantly higher than that in patients with peripheral blood (P <0.05). The intracellular IFN-γ levels were significantly different from those in two groups Cell changes consistent. After anti-TB treatment, the proportion of CD3 + T cells in peripheral blood and pleural effusion increased compared with that before treatment and the proportion of γδT cells decreased. The intracellular IFN-γ level was significantly lower than that before treatment (P <0.05). The percentage of CD4 + T cells in peripheral blood of patients with tuberculous pleurisy before antituberculous treatment was significantly lower than that in healthy controls (P <0.01), while the proportion of Th17 cells was significantly increased (P <0.01). The level of CD4 + T cells in pleural effusion was significantly higher Peripheral blood (P <0.05) and Th17 cells decreased significantly (P <0.05). There was no significant difference in the proportion of CD4 + T and Th17 cells in pleural effusion between the two groups after antituberculous therapy. There was no significant correlation between IL-17 + T and Th17 cells, while CD4 + RORγt + T and Th17 cells There was a significant correlation (r = 0.564, P <0.05). Conclusions There is a significant difference between γδT and Th17 cells before and after antituberculous therapy, suggesting that 2 groups of cells may play an important role in the pathogenesis and treatment of tuberculous pleurisy.