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目的探讨Th1/Th2免疫应答平衡在结核性和恶性肿瘤性胸腔积液病理生理过程中的可能作用。方法对24例治疗前结核性胸腔积液以及28例患者恶性胸腔积液患者胸液标本进行有核细胞计数、分类和流式细胞仪检测淋巴细胞亚群,检测CD3+,CD3+CD4+、CD3+CD8+T淋巴细胞亚群比例,并计算CD4+/CD8+值;利用夹心酶联免疫吸附测定(ELISA)法检测胸液标本中INF-γ、IL-18、TNF-α以及IL-10的浓度。结果结核性胸腔积液患者胸水中T辅助淋巴细胞以CD3+CD4+细胞为主,其CD3+细胞比例、CD3+CD4+细胞比例以及CD4+/CD8+值均高于恶性肿瘤性胸腔积液组(P<0.01)。2组研究对象INF-γ、IL-18、TNF-α以及IL-10的浓度分别是(中位数):结核性胸腔积液组942.0、1 526、62 pg/ml和153 pg/ml;恶性胸腔积液组10.35、1 763、8.85 pg/ml和66.85 pg/ml。结核性胸腔积液中INF-γ、TNF-α以及IL-10均明显高于恶性肿瘤性胸腔积液中的水平(P<0.01),且平均分别高约90倍、7倍和2倍。IL-18在2组胸腔积液中的含量无显著性差异(P>0.05)。结核性胸腔积液IL-18/IL-10明显低于恶性肿瘤性胸腔积液组(P<0.01)。结论结核性胸腔积液表现为Th1免疫应答为主;而恶性肿瘤性胸腔积液患者存在明显的细胞免疫功能低下。这种低下可能主要以T辅助淋巴细胞受损、Thl免疫应答降低以及Th2免疫应答升高为主。IFN-γ可作为鉴别结核性胸腔积液和恶性肿瘤性胸腔积液特异性和敏感度较高的指标。
Objective To investigate the possible role of Th1 / Th2 immune response balance in the pathophysiological process of tuberculous and malignant pleural effusion. Methods Twenty-four patients with tuberculous pleural effusion before treatment and 28 patients with malignant pleural effusion were enrolled in this study. Counting, classifying and counting lymphocyte subsets of pleural fluid in patients with malignant pleural effusion were performed to detect CD3 +, CD3 + CD4 +, CD3 + CD8 + T lymphocyte subsets and calculate the CD4 + / CD8 + value. The concentrations of INF-γ, IL-18, TNF-α and IL-10 in pleural effusion samples were determined by sandwich enzyme-linked immunosorbent assay (ELISA) Results T helper lymphocytes in pleural effusion were predominantly CD3 + CD4 + cells, and the ratio of CD3 + cells, CD3 + CD4 + cells and CD4 + / CD8 + in pleural effusion were higher than those in malignant pleural effusion (P <0.01) ). The concentrations of INF-γ, IL-18, TNF-α and IL-10 in the two groups were (median): 942.0, 1 526, 62 pg / ml and 153 pg / ml for tuberculous pleural effusion; Malignant pleural effusion group 10.35,1 763,8.85 pg / ml and 66.85 pg / ml. The levels of INF-γ, TNF-α and IL-10 in tuberculous pleural effusion were significantly higher than those in malignant pleural effusion (P <0.01), and were respectively about 90 times, 7 times and 2 times higher than those in malignant pleural effusion. IL-18 in the two groups of pleural effusion content was no significant difference (P> 0.05). Tuberculous pleural effusion IL-18 / IL-10 was significantly lower than the malignant pleural effusion group (P <0.01). Conclusions Tuberculous pleural effusion manifests itself as Th1 immune response, while patients with malignant pleural effusion have obvious cellular immune dysfunction. This decline may be mainly T-helper lymphocyte damage, Thl immune response and Th2 immune response-based. IFN-γ can be used as a marker to distinguish tuberculous pleural effusion and malignant pleural effusion specificity and sensitivity index.