Abstract：Objective To dynamically observe the cellular immune function of the patients with multidrug-resistant tuberculosis (MDR-TB) so as to provide supports for clinical diagnosis, treatment and rational drug use and to lay a preliminary foundation for immunotherapy for MDR-TB patients. Methods Drug sensitivity test were performed on 50 MDR-TB patients and 50 drug-susceptible TB (S-TB) patients by the absolute concentration method. 20 healthy controls were selected from the physical examination centre. Lymphocyte subsets (CD4+, CD3+ and CD8+, etc.) were analyzed by flow cytometry. Serum cytokines (IFN-γ, IL-2, IL-4 and IL-10, etc.) were detected by enzyme-linked immunosorbent assay (ELISA). Serological differences were compared among the MDR-TB patients, S-TB patients and healthy controls. Results No statistically significant difference was found in the percentage of CD3+ among the three groups. There were significant differences in the percentages of CD4+, CD8+ and CD4+/CD8+ between any two groups among the MDR-TB group, S-TB group and control group. There were also significant differences in the serum concentrations of IFN-γ, IL-2, IL-4 and IL-10 between the control group and MDR-TB group or S-TB group as well as in the serum concentrations of IL-2, IL-4 and IL-10 between the MDR-TB group and S-TB group. The serum levels of CD4+, IL-2, and CD4+/CD8+ ratio in the MDR-TB group were all significantly lower than those of the S-TB group, while CD8+, IL-4 and IL-10 in the MDR-TB group were all significantly higher than those of S-TB group (P<0.05). Conclusions The cellular immune function of tuberculosis patients is impaired, which manifests as declined percentage of CD4+ lymphocyte, elevated percentage of CD8+ lymphocyte, reduced or even inverted ratio of CD4+/CD8+. As compared with patients with drug-susceptible tuberculosis, the cellular immune function of the patients with multidrug-resistant tuberculosis is further exacerbated and presents more significant indicator changes. Their disease conditions are more complex and increase the difficulty of clinical treatment.
[1] WHO.WHO report 2008[EB/OL](2008-12-1)[2016-1-8]. http://www.who.int/tb/publications/global_report/2008. [2] Lazatevic V,NoltD,Flynn JL.Long-term control of Mycobacterium tuberculosis infection is mediated by dynamic imnmune response[J].J Immunol,2005,175(2):1107-1117. [3] Barrera SDL,Aleman M,Musella R,et al.IL-10 down-regulates costimulatory moolecules on Mycobacterium tuberculosis-pulsed macrophages and impairs the lytic activity of CD4 and CD8 CTL in tuberculosis patients[J].Clin Exp Immunol,2004,138(1):128-138. [4] Cooper AM,D'Souza C, Frank AA,et al.The course of Mycobactecium tuberculosis infection in the lungs of mice lacking expression of either perforin or granzyme mediated cytolytic mechanisms[J].Infect Immun,1997,65(3):1317-1320. [5] 于春宝,左云,王俊玲,等.肺结核病人细胞免疫功能的研究[J].临床肺科杂志,2008,13(2): 138-139,141. [6] Cagatay T,Kiran B,Yurt S,et al.Levels of tumornecrosis factor-alpha and IL-1 alpha in newly diagnosed and multidrug resistant tuberculosis[J]. Respirology,2005,10:290-294. [7] Shahemabadi AS,Hosseini AZ,Shaghsempour S,et al.Evaluation of T cell immune responses in multi-drug-resistant tuberculosis(MDR-TB) patients to Mycobacterium tuberculosis total lipid antigens[J].Clin Exp Immunol,2007,149:285-294. [8] Tsao TC,Chen CH,Hong JH,et al.Shifts of T4/T8 T lymphocytes from BAL fluid and peripheral blood by clinical grade in patients with pulmonary tuberculosis[J].Chest,2002,122:1285-1291. [9] 何纲,丁佩佩,甄沛林,等.非耐药与耐多药肺结核患者外周血T淋巴细胞亚群及细胞因子的变化[J]. 中国感染控制杂志,2013,12(9): 1671-1673. [10] Beck Js,Yoneda T.T4 lymphopenin in patients with active pulmonary tuberculosis[J].Clin Exp Immunol,1985,60:49-50. [11] 宋礼章.免疫疗法[J].哮喘与肺部疾病杂志,1998,2(1):10. [12] Quiroga MF,Pasquinelli V,Martinez GJ,et al.Inducible costimulator:a modulator of IFN-γ production in human tuberculosis[J].J Immunol,2006,176(10):5965-5974. [13] 张贤兰,吕江青,林兆原,等.肺结核患者CD4+T淋巴细胞凋亡及相关细胞因子水平变化[J].广东医学,2008,29(10):1664-1666. [14] 孙莹. 复治及耐多药结核病患者的Th1/Th2细胞状态变化的研究[D].济南:山东大学,2009. [15] Zhang M,Lin Y,Iyer DV,et al.T-cellcytokine responses in human infection with Mycobacterium tuberculosis[J].Infect Immun,1995,63(8):3231-3234. [16] 童健.MGIT960 法和绝对浓度法对耐多药结核杆菌药敏检测结果比较[J].实用预防医学,2015,22(3):366-368.
2016, Vol. 23 
