初治脊柱结核患者外周血T淋巴细胞亚群的变化和作用

发布时间：2018-05-06 13:15

本文选题：脊柱结核 + T淋巴细胞亚群　；参考：《昆明医科大学》2013年硕士论文

【摘要】：目的：通过检测脊柱结核患者外周血中T淋巴细胞亚群、细胞因子IFN-γ和IL-4在病程中不同时间点的变化,探讨脊柱结核患者机体免疫力变化的规律,为脊柱结核的个体化治疗方案的制定和调整提供一定的依据。材料和方法：采用单平台流式细胞技术,检测纳入病例组的51例初治患者外周血中T淋巴细胞亚群(CD3+、CD4+、CD8+、CD19+和NK)细胞的绝对数和百分数,并与健康对照组的相应指标进行比较；对其中36例进行手术治疗并于术后1-3天内完成T细胞亚群检测的病例进行术前和术后对比分析；对术后1月按时复诊的病例也进行相同的检测,与治疗前的T细胞亚群水平进行对比分析。上述病例中提取单个核细胞时获取的血浆样本低温保存,采用流式细胞技术进行IFN-γ和IL-4与蛋白水平检测,并与上述相应的时间点进行对比分析。结果：本组脊柱结核患者病例中,CD3+T淋巴细胞和CD4+T淋巴细胞绝对数和百分数均低于健康对照组,组间比较差别有统计学意义(P0.05)；而CD8+T、 CD19+和NK细胞的绝对数和百分数与健康对照组件比较无统计学差(P0.05)。手术前后组间比较,T细胞亚群中CD4+T细胞水平进一步减低(P0.05),其余(包括CD3+、CD8+、CD19+和NK)均无统计学差异(P0.05)。术后1月与治疗前检测对比分析,CD3+和CD4+T细胞亚群的绝对和百分数与治疗前相比组间具有统计学差异(P0.05),但仍低于正常组。细胞因子检测显示：脊柱结核患者治疗前IFN-γ蛋白水平均低于健康对照组,差别具有显著统计学意义(P0.01)；而IL-4蛋白水平组间比较差别无统计学意义(P0.05)。手术前后比较,IFN-γ和IL-4蛋白水平无明显的变化。手术后1月患者的IFN-γ有所提高,但仍低于正常水平(P0.05)。结论：脊柱结核患者T淋巴细胞的免疫功能下降,其中以CD4+T淋巴细胞绝对数和百分数降低为主；同时,主要由CD4+T淋巴细胞分泌为主的细胞因子IFN-γ的表达也受到明显的抑制。手术应激可进一步降低机体的免疫力。T细胞亚群和细胞因子IFN-γ和IL-4水平随着治疗时期的不同而变化,可较好的体现免疫力状态,为个体化治疗方案的制定提供重要的参考。
[Abstract]:Objective: to detect the changes of T lymphocyte subsets, cytokines IFN- 纬 and IL-4 in peripheral blood of patients with spinal tuberculosis at different time points during the course of disease, and to explore the changes of immunity in patients with spinal tuberculosis. To provide some basis for the formulation and adjustment of individual treatment of spinal tuberculosis. Materials and methods: single platform flow cytometry was used to detect the absolute number and percentage of T lymphocyte subsets (CD3, CD 4, CD 8, CD 8, CD 19 and NKC) in the peripheral blood of 51 newly treated patients, and compared with the corresponding indexes of the healthy control group. Among them, 36 cases who underwent surgical treatment and completed T cell subsets test within 1-3 days after operation were compared before and after operation, and those who returned on time in 1 month after operation were also tested. The level of T cell subsets was compared with that before treatment. The plasma samples obtained from the mononuclear cells were cryopreserved. The levels of IFN- 纬, IL-4 and protein were detected by flow cytometry, and compared with the corresponding time points. Results: the absolute number and percentage of CD3 T lymphocytes and CD4 T lymphocytes in patients with spinal tuberculosis were lower than those in healthy controls. The absolute numbers and percentages of CD8 T, CD19 and NK cells were not significantly different from those of healthy controls. The levels of CD4 T cells in the T cell subsets were further decreased before and after operation, while the rest (including CD3 CD8 + CD19 and NKK) had no significant difference (P 0.05). The absolute and percentage of CD3 and CD4 T cell subsets were significantly different from those before treatment (P 0.05), but were still lower than that of normal group (P < 0.05). The level of IFN- 纬 protein in patients with spinal tuberculosis before treatment was lower than that in healthy control group, and the difference was statistically significant (P 0.01), but there was no significant difference in IL-4 protein level between the two groups. There were no significant changes in IFN- 纬 and IL-4 protein levels before and after operation. IFN- 纬 was increased in patients at 1 month after operation, but it was still below the normal level (P 0.05). Conclusion: the immune function of T lymphocytes in patients with spinal tuberculosis was decreased, in which the absolute number and percentage of CD4 T lymphocytes were mainly decreased, and the expression of IFN- 纬, which was mainly secreted by CD4 T lymphocytes, was also significantly inhibited. The level of IFN- 纬 and IL-4 could be decreased by operation stress, which could reflect the immune state and provide an important reference for individual treatment.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R529.2

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