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目的 讨肺结核患者血清25-羟基维生素D[25-(OH)D]与血清T淋巴细胞亚群水平的变化及临床意义.方法 2012年2 月至2014年5月收集上海市徐汇区中心医院结核病防治门诊诊治的386例肺结核患者作为肺结核组;选取同期在医院进行健康体检的647名健康人群作为健康对照组.肺结核组中所有患者均进行了规范的抗结核药物治疗,采用数字表法随机选取 44例患者在抗结核药物治疗基础上增加维生素D治疗,作为治疗组;选取45例患者不增加维生素D治疗,作为治疗对照组.采用液相色谱-质谱联用法(LC-MS/MS)测定研究对象血清25-(OH)D2、25-(OH)D3和T淋巴细胞亚群CD3+、CD4+、CD8+绝对值水平,比较肺结核组与健康对照组,以及维生素D治疗组和治疗对照组上述指标的变化情况.结果 结核组患者25-(OH)D、25-(OH)D2、25-(OH)D3水平分别为31.3(22.5~41.5)、0.3(0.0~1.5)、31.9(22.3~41.1) nmol/L,明显低于健康对照组的42.0(34.3~51.5)、2.0(1.5~3.6)、40.1(31.9~49.5) nmol/L,差异有统计学意义(Z值分别为12.19、16.42、9.89,P值均<0.01);肺结核组CD3+、CD4+、CD8+绝对值水平分别为968.0(800.0~1164.0)、524.0(460.0~656.0)、394.0(288.0~512.0)个/μl,明显低于健康对照组的1324.0(1116.0~1568.0)、708.0(568.0~864.0)、524.0(412.0~652.0)个/μl,差异均有统计学意义(Z值分别为15.68、13.30、12.15,P值均<0.01).肺结核维生素D治疗组25-(OH)D3、25-(OH)D以及CD3+绝对值水平在治疗6个月分别为39.3(31.7~54.5) nmol/L、46.5(36.0~57.5) nmol/L、1268.0(1012.0~1448.0)个/μl,高于治疗对照组同期水平[39.3(34.3~45.8) nmol/L、38.0(33.8~44.8) nmol/L、1008.0(752.0~1212.0)个/μl],差异有统计学意义(Z值分别为2.57、1.45、2.41,P值分别为0.012、0.150、0.018).结论 结核患者血清25-(OH)D及外周血T淋巴细胞亚群水平低下,纠正维生素D的缺乏或不足可改善患者的细胞免疫功能.“,”Objective To investigate the changes and clinical significance of serum 25-hydroxy vitamin D (25-(OH)D) and peripheral blood T lymphocyte subsets levels in patients with pulmonary tuberculosis.Methods From Feb 2012 to May 2014, 386 cases of pulmonary tuberculosis patients and 647 healthy controls in Shanghai Xuhui Center Hospital were enrolled.All cases received standard anti-tuberculosis treatment.By using random number method, 44 patients were assigned to receive standard anti-tuberculosis treatment and vitamin D therapy (vitamin D treatment group), while 45 patients were assigned to receive standard anti-tuberculosis treatment only (control group).By using liquid chromatography and mass spectrometry (LC-MS/MS), serum 25-(OH)D2, 25-(OH)D3, CD3+, CD4+, CD8+ T lymphocyte subsets levels were determined in all subjects.The changes were compared between pulmonary tuberculosis patients and healthy controls as well as between vitamin D treatment and control groups.Results The levels of 25-(OH)D, 25(OH)D2, and 25(OH)D3 in pulmonary tuberculosis patients (31.3 (22.5-41.5), 0.3 (0.0-1.5), and 31.9 (22.3-41.1) nmol/L) were significantly lower than those in the healthy controls (42.0 (34.3-51.5), 2.0 (1.5-3.6), and 40.1 (31.9-49.5) nmol/L);the differences were statistically significant (Z=12.19, 16.42, and 9.89, respectively;all P<0.01).The CD3+, CD4+, and CD8+ absolute value levels in pulmonary tuberculosis patients (968.0(800.0-1164.0)/μl, 524.0 (460.0-656.0)/μl, and 394.0 (288.0-512.0)/μl) were significantly lower than those in healthy controls (1324.0 (1116.0-1568.0)/μl, 708.0 (568.0-864.0)/μl, and 524.0 (412.0-652.0)/μl);the differences were statistically significant (Z=15.68, 13.30, and 12.15, respectively;all P<0.01).In the vitamin D treatment group, the levels of 25-(OH)D3, 25-(OH)D, CD3+ after 6 months of treatment were 39.3 (31.7-54.5) nmol/L, 46.5 (36.0-57.5) nmol/L and 1268.0 (1012.0-1448.0)/μl, which were higher compared with the control group (39.3 (34.3-45.8) nmol/L, 38.0 (33.8-44.8) nmol/L and 1008.0 (752.0-1212.0)/μl;the differences were statistically significant (Z=2.57, 1.45, 2.41, respectively;P=0.012, 0.150, 0.018, respectively).Conclusion The levels of serum 25-(OH)D and peripheral blood T lymphocyte subsets in patients with pulmonary tuberculosis are decreased.Correcting vitamin D deficiency/insufficiency can improve cellular immune function of patients with pulmonary tuberculosis.