Th1/Th2细胞及细胞因子和结核性胸膜炎粘连的相关性
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摘要
目的探讨结核性胸膜炎患者不同胸膜粘连程度和Th1、Th2细胞免疫的相关性。方法选取2014年8月至2016年12月住院的66例行内科胸腔镜手术确诊为结核性胸膜炎患者,测定胸水和血清中INF-γ、TNF-α、IL-2、IL-4的含量,应用流式细胞术检测胸水Th1、Th2细胞比例。结果患者分为无胸膜粘连组9例,轻度胸膜粘连组32例,重度胸膜粘连组25例。每组胸液中4种细胞因子均较血清中含量升高,差异有显著性。3组患者胸液中INF-γ、TNF-α的平均浓度随胸膜粘连程度加重而逐渐升高,重度胸膜粘连组INF-γ、TNF-α水平明显高于另外两组,差异均有显著性(P<0.05)。重度胸膜粘连组的Th1细胞比例明显高于无胸膜粘连组和轻度胸膜粘连组,差异有显著性(P<0.05)。结论结核性胸膜炎胸液中Th1细胞比例及INF-γ、TNF-α含量越高,胸膜的粘连程度越明显,证实过度强烈的Th1型细胞免疫反应能够对胸膜组织造成病理性免疫损伤,与胸膜粘连严重程度相关。
Objective To investigate the relationship between cellular immune response which is related with Th1/Th2 cells and the different severities of tuberculosis pleural effusion adhesion. Methods A total of 66 inpatients diagnosed with different severities of tuberculosis pleural effusion adhesion by internal thoracoscope were enrolled from August 2014 to December 2016. ELISA was used to determine levels of INF-γ,TNF-α,IL-2 and IL-4. The ratio of Th1 and Th2 cells was detected by flow cytometry. Results All the patients were divided into 3 groups:9 cases without pleural adhesion,32 cases with mild pleural adhesion,25 cases with severe pleural adhesion. The levels of 4 cytokines in pleural fluid were significantly higher than those in serum in each group(P <0.05,respectively). The concentrations of INF-γ and TNF-α were increased with the severity of tuberculosis pleural effusion adhesion. The levels of INF-γ and TNF-α in the severe pleural adhesion group were markedly higher than those in the other two groups(P < 0.05,respectively). The proportion of Th1 cells in the severe pleural adhesion group was significantly higher than that in the none pleural adhesion group and in the mild pleural adhesion group(P < 0.05,respectively). Conclusions The proportion of Th1 cells and levels of INF-γ and TNF-α are positively related with pleural adhesion severity. Cellular immune response which is related with Th1 cells contributes to pathological immune pleural damage and intensify the severity of pleural adhesions.
Objective To investigate the relationship between cellular immune response which is related with Th1/Th2 cells and the different severities of tuberculosis pleural effusion adhesion. Methods A total of 66 inpatients diagnosed with different severities of tuberculosis pleural effusion adhesion by internal thoracoscope were enrolled from August 2014 to December 2016. ELISA was used to determine levels of INF-γ,TNF-α,IL-2 and IL-4. The ratio of Th1 and Th2 cells was detected by flow cytometry. Results All the patients were divided into 3 groups:9 cases without pleural adhesion,32 cases with mild pleural adhesion,25 cases with severe pleural adhesion. The levels of 4 cytokines in pleural fluid were significantly higher than those in serum in each group(P <0.05,respectively). The concentrations of INF-γ and TNF-α were increased with the severity of tuberculosis pleural effusion adhesion. The levels of INF-γ and TNF-α in the severe pleural adhesion group were markedly higher than those in the other two groups(P < 0.05,respectively). The proportion of Th1 cells in the severe pleural adhesion group was significantly higher than that in the none pleural adhesion group and in the mild pleural adhesion group(P < 0.05,respectively). Conclusions The proportion of Th1 cells and levels of INF-γ and TNF-α are positively related with pleural adhesion severity. Cellular immune response which is related with Th1 cells contributes to pathological immune pleural damage and intensify the severity of pleural adhesions.
引文
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[2]YUAN M I,TONG Z H,JIN X G,et al.Regulation of CD4+Tcells by pleural mesothelial cells via adhesion molecule-dependent mechanisms in tuberculous pleurisy[J].PLo S One,2013,8(9):e74624.
[3]ONCEL M,REMZI F H,SENAGORE A J,et al.Comparison of a novel liquid(Adcon-P)and a sodium hyaluronate and carboxymethylcellulose membrane(Seprafilm)in postsurgical adhesion formation in a murine model[J].Diseases Colon&Rectum,2003,46(2):187-191.
[4]张艳,郑建,黄捷晖,等.胸腔镜下结核性胸膜炎胸膜粘连程度的判定及相关因素分析[J].南京医科大学学报(自然科学版),2012,32(10):1422-1425.
[5]KWON J S,CHA S I,JEON K N,et al.Factors influencing residual pleural opacity in tuberculous pleural effusion[J].J Korean Med Sci,2008,23(4):616-620.
[6]WANG Z,XU L L,WU Y B,et al.Diagnostic value and safety of medical thoracoscopy in tuberculous pleural effusion[J].Respiratory Medicine,2015,109(9):1188-1192.
[7]吴欢欢,李玉萍,官岚.结核性胸膜炎患者内科胸腔镜表现[J].实用医学杂志,2012,28(8):1310-1312.
[8]KAUFMANN S H,COLE S T,MIZRAHI V,et al.Mycobacterium tuberculosis and the host response[J].J Exp Med,2005,201(11):1693-1697.
[9]肖玲,温武金,辜海文,等.Th细胞免疫与结核性胸膜炎胸膜粘连关系的研究[J].中国实用内科杂志,2008,28(2):116-118.
[10]戈启萍,贺正一,高微微,等.流式细胞术检测特异性刺激后淋巴细胞亚群变化对结核性胸腔积液的诊断价值[J].中华结核和呼吸杂志,2013,36(6):406-410.
[11]BEHAR S M,SASSETTI C M.Immunology:fix the odds against tuberculosis[J].Nature,2014,511(7507):39-40.
[12]吴文奇,谢永平,彭彩红,等.联合检测ADA和PCT在结核性胸膜炎诊断及鉴别诊断中的应用[J].现代医院,2017,17(3):456-457,460.
[13]XIONG W J,DONG H P,WANG J J,et al.Analysis of plasma cytokine and chemokine profile in patients with and without tuberculosis by liquid array-based multiplexed immunoassays[J].PLo S One,2016,11(2):e0148885.
[14]孙勇.电子纤支镜在胸腔积液诊治中的临床价值分析[J].现代医院,2016,16(1):57-59.
[15]TONG Z H,SHI H Z.Subpopulations of helper T lymphocytes in tuberculous pleurisy[J].Tuberculosis,2013,93(3):279-284.
[16]LI L,QIAO D,LI Q,et al.Distinct polyfunctional CD4+T cell responses to BCG,ESAT-6 and CFP-10 in tuberculous pleurisy[J].Tuberculosis,2012,92(1):63-71.
[17]KIROPOUIOS T S,KOSTIKAS K,OIKONOMIDI S,et al.Acute phase markers for the differentiation of infectious and malignant pleural effusions[J].Respir Med,2007,101(5):910-918.
[18]SEISCENTO M,VAEGAS F S,ACENCIO M M,et al.Pleural fluid eytokines correlate with tissue inflammatory expression in tuberculosis[J].Int J Tuberc Lung Dis,2010,14(9):1153-1158.