摘要
目的探讨初治继发性肺结核不同CT征象外周血淋巴细胞亚群的差异。方法采用回顾性分析,搜集2020年1月~2021年6月初治药物敏感继发性肺结核患者65例,治疗前均行胸部CT检查及外周血淋巴细胞亚群绝对计数检测(CD3^(+)、CD8^(+)、CD4^(+)T淋巴细胞绝对计数及CD4^(+)/CD8^(+)比值、B淋巴细胞绝对计数、NK细胞绝对计数),分析不同CT征象外周血淋巴细胞亚群之间的差异。数据符合偏态分布,采用中位数及四分位数间距[M(Q1,Q3)]表示,使用非参数Wilcoxon两样本秩和检验。结果肺结核病灶累及≥4个肺段的外周血CD3^(+)T淋巴细胞、B淋巴细胞、NK细胞绝对计数分别为942.240(750.380,942.240)个/微升、144.240(119.075,227.770)个/微升和127.180(100.290,164.260)个/微升,均低于<4个肺段的1028.385(900.993,1366.833)个/微升、220.465(164.865,301.360)个/微升和168.380(136.978,210.138)个/微升,差异均有统计学意义(Z=-2.360,P=0.018;Z=-2.778,P=0.005;Z=-2.656,P=0.008);干酪性肺炎为主型的外周血CD3^(+)、CD8^(+)、CD4^(+)T淋巴细胞及NK细胞绝对计数分别为852.585(624.833,991.250)个/微升、288.380(257.338,371.198)个/微升、457.960(368.238,611.820)个/微升和108.510(97.383,205.045)个/微升,均低于渗出浸润为主型的1040.220(920.510,1307.145)个/微升、374.750(320.145,468.865)个/微升、594.720(453.760,720.455)个/微升和158.030(133.380,200.235)个/微升,差异均有统计学意义(Z=-3.381,P=0.001;Z=-3.213,P=0.001;Z=-2.391,P=0.017;Z=-2.147,P=0.032);合并空洞的外周血CD8^(+)T淋巴细胞及NK细胞绝对计数分别为304.470(261.800,377.110)个/微升和111.450(95.570,160.000)个/微升,均低于无空洞的365.835(311.745,457.833)个/微升和161.255(129.925,207.893)个/微升,差异均有统计学意义(Z=-2.164,P=0.030;Z=-2.335,P=0.020);合并结核胸膜炎的外周血CD3^(+)、CD4^(+)T淋巴细胞绝对计数及CD4^(+)/CD8^(+)比值、B淋巴细胞绝对计数分别为804.895(727.945,998.515)个/微升、408.365(318.280,611.903)个/微升、1.330(1.058,1.828)和152.855(129.670,204.788)个/微升,均低于无结核性胸膜炎的1040.220(979.180,1311.530)个/微升、611.980(488.890,702.070)个/微升、1.720(1.220,2.100)和224.680(158.380,299.590)个/微升,差异均有统计学意义(Z=-4.034,P=0.000;Z=-3.397,P=0.001;Z=-2.038,P=0.042;Z=-2.773,P=0.006)。而肺结核优势肺段(尖后段及背段)与优势肺段合并其他肺段两组淋巴细胞亚群指标差异均无统计学意义。结论初治继发性肺结核患者CT征象可以直观初步预测外周血淋巴细胞亚群绝对计数的高低,便于临床医师对患者免疫功能做出早期评估。
Objective To investigate the difference of peripheral blood lymphocyte subsets with different CT signs in initial-treated secondary pulmonary tuberculosis.Methods A retrospective analysis was conducted.65 patients were included with initial-treated drug-sensitive secondary tuberculosis from January 2019 to June 2021.The chest computed tomography(CT)examination and absolute count of peripheral blood lymphocyte subsets were performed before treatment(absolute count of CD3^(+),CD8^(+),CD4^(+)T lymphocytes and the ratio of CD4^(+)/CD8^(+),absolute count of B lymphocytes and absolute count of NK cells).The difference of peripheral blood lymphocyte subsets with different CT signs was analyzed.The data conform to the skewed distribution,were indicated using the median and interquartile range[M(Q1,Q3)],and were compared using the non-parametric Wilcoxon two-sample rank sum test.Results The absolute counts of CD3^(+)T lymphocytes,B lymphocytes and NK cells in peripheral blood of pulmonary tuberculosis lesions involving≥4 pulmonary segments were 942.240(750.380,942.240)cells/μl,144.240(119.075,227.770)cells/μl and 127.180(100.290,164.260)cells/μl,re-spectively,which were lower than<4 lung segments 1028.385(900.993,1366.833)cells/μl,220.465(164.865,301.360)cells/μl and 168.380(136.978,210.138)cells/μl,and the differences were statistically significant(Z=-2.360,P=0.018;Z=-2.778,P=0.005;Z=-2.656,P=0.008).The absolute counts of CD3^(+),CD8^(+),CD4^(+)T lymphocytes and NK cells in peripheral blood of caseated pneumonia were 852.585(624.833,991.250)cells/μl,288.380(257.338,371.198)cells/μl,457.960(368.238,611.820)cells/μl and 108.510(97.383,205.045)cells/μl,respectively,which were lower than exudative infiltration 1040.220(920.510,1307.145)cells/μl,374.750(320.145,468.865)cells/μl,594.720(453.760,720.455)cells/μl and 158.030(133.380,200.235)cells/μl,and the differences were statistically significant(Z=-3.381,P=0.001;Z=-3.213,P=0.001;Z=-2.391,P=0.017;Z=-2.147,P=0.032).The absolute counts of CD8^(+)T lymphocytes and NK cells in peripheral blood with cavities were 304.470(261.800,377.110)cells/μl and 111.450(95.570,160.000)cells/μl,which were lower than without cavities 365.835(311.745,457.833)cells/μl and 161.255(129.925,207.893)cell/μl,and the difference were statistically significant(Z=-2.164,P=0.030;Z=-2.335,P=0.020).The absolute counts of CD3^(+),CD4^(+)T lymphocytes,CD4^(+)/CD8^(+)ratios,abso-lute counts of B lymphocytes in peripheral blood with tuberculosis pleurisy were 804.895(727.945,998.515)cells/μl,408.365(318.280,611.903)cells/μl,1.330(1.058,1.828)and 152.855(129.670,204.788)cells/μl,which were lower than without tu-berculous pleurisy 1040.220(979.180,1311.530)cells/μl,611.980(488.890,702.070)cells/μl,1.720(1.220,2.100)and 224.680(158.380,299.590)cells/μl,and the difference were statistically significant(Z=-4.034,P=0.000;Z=-3.397,P=0.001;Z=-2.038,P=0.042;Z=-2.773,P=0.006).However,there were no significant differences in lymphocyte subsets be-tween the dominant lung segment(post-apical and dorsal segment)and the dominant lung segment combined with other lung segments.Conclusion CT signs of initial-treated secondary pulmonary tuberculosis patients can directly predict the absolute count of peripheral blood lymphocyte subsets,which is convenient for clinician early evaluation patients′immune function.
作者
户彦龙
窦文广
朱止平
薛明媚
刘苏娟
梁长华
HU Yanlong;DOU Wenguang;ZHU Zhiping(Department of Radiology,the First Affiliated Hospital of Xinxiang Medical Universi-ty,Henan 453100,China)
出处
《医学研究杂志》
2022年第2期97-101,83,共6页
Journal of Medical Research
基金
河南省医学科技攻关计划联合共建项目(LHGJ20200520)。
关键词
肺结核
淋巴细胞亚群
免疫
计算机断层成像
Tuberculosis,pulmonary
Lymphocyte subsets
Immunity
Computed tomography
作者简介
通信作者:梁长华,主任医师,电子信箱:liangchanghua12345@163.com。
