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目的:探讨肺结核在同一患者肺部感染部位的差异。方法随机选取我科一侧肺部正常的复治肺结核患者20例,每例均痰涂片找抗酸杆菌>3次阴性。①取治疗前外周血标本和治疗后2个月外周血标本查CD_3、CD_4、CD_8、NK细胞及CD_4/CD_8比值;②选取病变累及的肺段作为灌洗部位,同时选中对侧没有病变的肺段作为对照。取灌洗液查CD_3、CD_4、CD_8、NK细胞及CD_4/CD_8比值,同时取灌洗液找抗酸杆菌和结核菌培养。结果病变累及的肺段支气管肺泡灌洗液中CD_3T细胞明显低于没有病变累及的肺段组,CD_4T细胞、CD_4/CD_8、NK细胞明显低于病变没有累及的对侧肺段组。抗结核治疗2个月后CD_3、CD_4/CD_8比值较治疗前明显上升,CD_4、CD_8T细胞治疗前后差异无显著,NK细胞治疗前后明显上升。结论复治痰菌阴性肺结核患者肺部正常与不正常部位存在CD_3、CD_4、NK细胞和CD_4/CD_8比值不同同局部细胞免疫功能有关。
Objective: To investigate the difference of pulmonary tuberculosis in the same patients with pulmonary infection. Methods Twenty patients with pulmonary tuberculosis whose lungs were normal in our department were randomly selected, and sputum smear of every patient was found to be negative for acid-fast bacilli> 3 times. (1) The peripheral blood samples before treatment and 2 weeks after treatment were examined for the ratio of CD_3, CD_4, CD_8, NK cells and CD_4 / CD_8; ②Select the affected lung segments as the lavage site, Pulmonary segment as a control. Take perfusate to check the ratio of CD_3, CD_4, CD_8, NK cells and CD_4 / CD_8, at the same time take the wash solution to find Acid-fast bacilli and Mycobacterium tuberculosis culture. Results The number of CD_3T cells in bronchoalveolar lavage fluid was significantly lower than that in non - affected lung segments. CD_4T cells, CD_4 / CD_8 and NK cells were significantly lower than those in the contralateral lung segments. After 2 months of anti-TB treatment, the ratio of CD_3 and CD_4 / CD_8 increased significantly compared with that before treatment. There was no significant difference between before and after treatment of CD_4 and CD_8T cells, and NK cells increased obviously before and after treatment. Conclusions The differences of CD_3, CD_4, NK cells and CD_4 / CD_8 ratios between the normal and abnormal parts of the lung in patients with sputum bacteremia - negative pulmonary tuberculosis are related to local cellular immune function.