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目的:探讨肺结核在同一患者肺部感染部位差异的原因。方法:随机选取我科一侧肺部正常的初治痰菌阴性肺结核患者22例。(1)取治疗前及治疗后2个月外周血标本查CD3、CD4、CD8、自然杀伤细胞(NK细胞)及CD4/CD8。(2)选取病变累及的肺段作为灌洗部位,同时选对侧正常肺段作为对照。取灌洗液查CD3、CD4、CD8、NK细胞及CD4/CD8,同时取灌洗液查抗酸杆菌并进行结核菌培养。结果:治疗前外周血中CD8T细胞明显升高,CD4T细胞、CD4/CD8、NK细胞明显降低;抗结核治疗2个月后与治疗前相比,CD8T细胞降低,但差异无统计学意义(P>0.05),CD4T细胞、CD4/CD8比值、NK细胞增高,差异均有统计学意义(P<0.05或P<0.01);病变侧肺段支气管肺泡灌洗液中CD8T细胞明显高于正常侧,CD4T细胞、CD4/CD8、NK细胞明显低于对侧正常肺段组(P<0.05或P<0.01)。结论:初治痰菌阴性肺结核患者肺部正常与病变部位存在CD4、CD8、NK细胞和CD4/CD8的差异,这些差异同局部细胞免疫功能有关。
Objective: To investigate the causes of pulmonary tuberculosis in the same patients with pulmonary infection. Methods: Twenty-two patients with initially untreated sputum negative pulmonary tuberculosis were selected randomly from our hospital. (1) CD3, CD4, CD8, natural killer (NK) cells and CD4 / CD8 were detected in peripheral blood samples before treatment and 2 months after treatment. (2) select the lesion involving the lung segment as a lavage site, while the contralateral normal lung segment as a control. Take lavage fluid check CD3, CD4, CD8, NK cells and CD4 / CD8, at the same time check the antifungal bacilli and Mycobacterium tuberculosis culture. Results: Before treatment, CD8 T cells in peripheral blood were significantly increased and CD4 T cells, CD4 / CD8 and NK cells were significantly decreased. CD8 T cells decreased after 2 months of anti-TB treatment compared with that before treatment, but the difference was not statistically significant (P (P <0.05 or P <0.01). CD8 T cells in the bronchioalveolar lavage fluid in the lateral lung segment of the lesion were significantly higher than those in the normal side (P> 0.05), and the ratio of CD4 T cells, CD4 / CD8 and NK cells were significantly increased CD4 T cells, CD4 / CD8, NK cells were significantly lower than the contralateral normal lung segment (P <0.05 or P <0.01). Conclusion: There are differences of CD4, CD8, NK cells and CD4 / CD8 between the normal and diseased lungs in sputum negative sputum negative pulmonary tuberculosis patients. These differences are related to the local cellular immune function.