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Article(id=1202979643453305574, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1202979639087030850, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.0994.2022.0715, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1651075200000, receivedDateStr=2022-04-28, revisedDate=null, revisedDateStr=null, acceptedDate=1654704000000, acceptedDateStr=2022-06-09, onlineDate=1764742297280, onlineDateStr=2025-12-03, pubDate=1690473600000, pubDateStr=2023-07-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1764742297280, onlineIssueDateStr=2025-12-03, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1764742297280, creator=13701087609, updateTime=1764742297280, updator=13701087609, issue=Issue{id=1202979639087030850, tenantId=1146029695717560320, journalId=1189873630562394117, year='2023', volume='48', issue='7', pageStart='749', pageEnd='870', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1764742296239, creator=13701087609, updateTime=1764742346610, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1202979850442203282, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1202979639087030850, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1202979850442203283, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1202979639087030850, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=756, endPage=760, ext={EN=ArticleExt(id=1202979643860153081, articleId=1202979643453305574, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Variance analysis of T cell subsets and blood indicators in different types of pulmonary tuberculosis, columnId=1202979639976223301, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Special Issue Ⅱ on Prevention, Diagnosis and Treatment of Tuberculosis, runingTitle=null, highlight=null, articleAbstract=

Objective To determine the diversity between the different types of pulmonary tuberculosis, a retrospective analysis was made on the characteristics of medical history, blood indicators and the characteristics of peripheral T cell subsets of these patients. Methods The data of 283 pulmonary tuberculosis patients with full information were analyzed in the Eighth Medical Center of Chinese PLA General Hospital from January 2018 to December 2021, who had definite diagnosis, neither diabetes nor drug resistance, and were all on the initial treatment. The patients were divided into four groups: secondary pulmonary tuberculosis group (PTB group, 186 cases), tracheal and bronchial tuberculosis group (BTB group, 23 cases), tuberculous pleurisy group (TBP group, 42 cases) and hematogenous disseminated pulmonary tuberculosis group (DTB group, 32 cases). The patients' general conditions, medical history characteristics, laboratory indicators and T cell subsets, etc. were analyzed comparatively. Results There were no statistical differences in the age, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), leukocyte count, lymphocyte count and hemoglobin level of patients between PTB group, BTB group, TBP group and DTB group(P>0.05). Compared with other groups, the proportion of men (34.8%) and the smoking rate (8.8%) were lower, and the disease course was longer (only 39.1% for the patients less than 3 months) in BTB group (P<0.05); the platelet count [308.00(242.00, 432.75.00)×109/L] and carbohydrate antigen 125 (CA125) level [69.10(40.94, 185.40) U/ml] were higher, the albumin level[34.50(29.60, 39.20) g/L] was lower, and the disease course was shorter (88.1% for the patients less than 3 months) in TBP group;the NK cell count [70.00(33.50, 218.50) cells/μl] and NK cell percentage [7.09%(4.38%, 11.87%)] were lower in DTB group;the differences were statistically significant (P<0.05). Conclusions Male patients are more likely to suffer from TBP and female patients are more likely to suffer from BTB. Platelet counts and CA125 level are higher in patients with TBP, while the counts and proportion of NK cells are lower in patients with DTB.

, correspAuthors=Tao Wang, authorNote=null, correspAuthorsNote=
* E-mail:
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目的 分析不同类型肺结核患者的病史、血液学指标及外周血淋巴细胞亚群的差异。方法 选取2018年1月－2021年12月解放军总医院第八医学中心结核病医学部结核病科收治的283例资料完整、诊断明确的初治、不耐药、无糖尿病的肺结核患者，分为继发性肺结核(PTB)组186例，气管、支气管结核(BTB)组23例，结核性胸膜炎(TBP)组42例及血行播散型肺结核(DTB)组32例，比较各组患者的一般资料、病史特点、血液检测指标及外周血淋巴细胞亚群的差异等。结果 PTB、BTB、TBP、DTB组患者的年龄、红细胞沉降率(ESR)、C-反应蛋白(CRP)、白细胞计数、淋巴细胞计数、血红蛋白水平比较差异均无统计学意义(P>0.05)。与其他组比较，BTB组男性比例(34.8%)及吸烟比例(8.8%)较低，病程较长(<3个月者占39.1%)，TBP组血小板计数[308.00(242.00，432.75.00)×109/L]及糖类抗原125[CA125，69.10(40.94，185.40) U/ml]水平较高，白蛋白[34.50(29.60，39.20) g/L]水平较低，病程较短(<3个月者占88.1%)，DTB组NK细胞计数[70.00(33.50，218.50)个/μl]及NK细胞百分比[7.09%(4.38%，11.87%)]较低，差异均有统计学意义(P<0.05)。结论 TBP患者中男性比例更高，BTB患者中女性比例更高，TBP患者的血小板计数及CA125水平更高，而DTB患者的NK细胞计数及百分比更低。

, correspAuthors=王涛, authorNote=null, correspAuthorsNote=
王涛，E-mail：
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俞珊，博士研究生，主要从事中西医结合防治结核病的研究

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俞珊，博士研究生，主要从事中西医结合防治结核病的研究

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俞珊，博士研究生，主要从事中西医结合防治结核病的研究

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PLoS One, 2019, 14(12): e0225611., articleTitle=Undernutrition is associated with perturbations in T cell-, B cell-, monocyte-and dendritic cell- subsets in latent Mycobacterium tuberculosis infection, refAbstract=null), Reference(id=1203005087300935941, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979643453305574, doi=null, pmid=null, pmcid=null, year=2021, volume=46, issue=3, pageStart=274, pageEnd=279, url=null, language=null, rfNumber=[18], rfOrder=25, authorNames=Ren RL, Zhang WX, Zhou W, journalName=Med J Chin PLA, refType=null, unstructuredReference=Ren RL, Zhang WX, Zhou W, et al. Clinical analysis of pulmonary tuberculosis and extrapulmonary tuberculosis complicated in maintenance hemodialysis patients with end-stage renal disease[J]. Med J Chin PLA, 2021, 46(3): 274-279., articleTitle=Clinical analysis of pulmonary tuberculosis and extrapulmonary tuberculosis complicated in maintenance hemodialysis patients with end-stage renal disease, refAbstract=null), Reference(id=1203005087380627721, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979643453305574, doi=null, pmid=null, pmcid=null, year=2021, volume=46, issue=3, pageStart=274, pageEnd=279, url=null, language=null, rfNumber=[18], rfOrder=26, authorNames=任瑞霖, 张五星, 周伟, journalName=解放军医学杂志, refType=null, unstructuredReference=[任瑞霖, 张五星, 周伟, 等. 终末期肾病维持性血液透析患者并发肺结核与肺外结核的临床特点[J]. 解放军医学杂志, 2021, 46(3): 274-279.], articleTitle=终末期肾病维持性血液透析患者并发肺结核与肺外结核的临床特点, refAbstract=null), Reference(id=1203005087502262542, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979643453305574, doi=null, pmid=null, pmcid=null, year=2020, volume=42, issue=10, pageStart=1009, pageEnd=1016, url=null, language=null, rfNumber=[19], rfOrder=27, authorNames=Editorial Board of Chinese Jounal of Antituberculosis, journalName=Chin J Antitubercul, refType=null, unstructuredReference=Editorial Board of Chinese Jounal of Antituberculosis. 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Chin J Antitubercul, 2020, 42(10): 1009-1016., articleTitle=Expert consensus on detection and clinical application of peripheral blood lymphocyte subsets in patients with tuberculosis, refAbstract=null), Reference(id=1203005087594537235, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979643453305574, doi=null, pmid=null, pmcid=null, year=2020, volume=42, issue=10, pageStart=1009, pageEnd=1016, url=null, language=null, rfNumber=[19], rfOrder=28, authorNames=《中国防痨杂志》编辑委员会, journalName=中国防痨杂志, refType=null, unstructuredReference=[《中国防痨杂志》编辑委员会. 结核病患者外周血淋巴细胞亚群检测及临床应用专家共识[J]. 中国防痨杂志, 2020, 42(10): 1009-1016.], articleTitle=结核病患者外周血淋巴细胞亚群检测及临床应用专家共识, refAbstract=null), Reference(id=1203005087665840404, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979643453305574, doi=null, pmid=null, pmcid=null, year=2021, volume=12, issue=null, pageStart=640168, pageEnd=null, url=null, language=null, rfNumber=[20], rfOrder=29, authorNames=Rijnink WF, Ottenhoff THM, Joosten SA, journalName=Front Immunol, refType=null, unstructuredReference=Rijnink WF, Ottenhoff THM, Joosten SA. B-Cells and antibodies as contributors to effector immune responses in tuberculosis[J]. Front Immunol, 2021, 12: 640168., articleTitle=B-Cells and antibodies as contributors to effector immune responses in tuberculosis, refAbstract=null)], funds=[Fund(id=1203005084465586337, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979643453305574, awardId=82072233, language=EN, fundingSource=National Natural Science Foundation of China(82072233), fundOrder=null, country=null), Fund(id=1203005084536889508, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979643453305574, awardId=82072233, language=CN, fundingSource=国家自然科学基金面上项目(82072233), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1203005079877018490, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979643453305574, xref=null, ext=[AuthorCompanyExt(id=1203005079885407099, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979643453305574, companyId=1203005079877018490, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Tuberculosis, Senior Department of Tuberculosis, the Eighth Medical Center of Chinese PLA General Hospital, Beijing 100091, China), AuthorCompanyExt(id=1203005079889601405, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979643453305574, companyId=1203005079877018490, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=解放军总医院第八医学中心结核病医学部结核病科，北京 100091)])], figs=[ArticleFig(id=1203005083748360312, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979643453305574, language=EN, label=Tab. 1, caption=

Basic information of tuberculosis patients in each group [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
指标PTB组(n=186)BTB组(n=23)TBP组(n=42)DTB组(n=32)χ2P
年龄<60岁131(70.5)17(73.9)27(64.3)20(62.5)1.5020.682
男性121(65.1)8(34.8)(1)32(76.2)(1)(2)16(50.0)(3)13.5550.004
吸烟史61(32.7)2(8.8)(1)17(40.5)(2)6(18.8)(3)9.6950.021
饮酒史32(17.2)2(8.7)6(14.3)2(6.3)3.3880.336
病程<3个月116(62.4)9(39.1)(1)37(88.1)(1)(2)19(59.4)(3)15.1910.002
标本抗酸杆菌阳性128(68.8)18(78.3)5(11.9)(1)3(9.4)(1)44.050<0.001
标本分子生物学阳性152(81.7)23(100.0)(1)9(21.4)(2)11(34.4)(1)(2)(3)77.595<0.001
), ArticleFig(id=1203005083840635006, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979643453305574, language=CN, label=表1, caption=

各组肺结核患者一般资料比较[例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
指标PTB组(n=186)BTB组(n=23)TBP组(n=42)DTB组(n=32)χ2P
年龄<60岁131(70.5)17(73.9)27(64.3)20(62.5)1.5020.682
男性121(65.1)8(34.8)(1)32(76.2)(1)(2)16(50.0)(3)13.5550.004
吸烟史61(32.7)2(8.8)(1)17(40.5)(2)6(18.8)(3)9.6950.021
饮酒史32(17.2)2(8.7)6(14.3)2(6.3)3.3880.336
病程<3个月116(62.4)9(39.1)(1)37(88.1)(1)(2)19(59.4)(3)15.1910.002
标本抗酸杆菌阳性128(68.8)18(78.3)5(11.9)(1)3(9.4)(1)44.050<0.001
标本分子生物学阳性152(81.7)23(100.0)(1)9(21.4)(2)11(34.4)(1)(2)(3)77.595<0.001
), ArticleFig(id=1203005083924521093, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979643453305574, language=EN, label=Tab. 2, caption=

Comparison of blood biochemical indexes of tuberculosis patients in each group [M(Q1, Q3)]

, figureFileSmall=null, figureFileBig=null, tableContent=
血液检测指标PTB组(n=186)BTB组(n=23)TBP组(n=42)DTB组(n=32)H(K)P
白细胞计数(×109/L)6.70(5.10,8.40)6.90(4.68,8.80)5.70(5.30,8.10)5.70(4.95,9.10)1.1470.766
淋巴细胞计数(×109/L)1.25(1.00,1.51)1.25(0.96,1.60)1.22(0.95,1.45)0.76(0.71,1.76)3.5500.314
血红蛋白(g/L)128.00(113.00,139.50)124.00(116.00,135.00)124.00(106.00,145.00)117.00(105.5,125.50)3.5860.310
血小板(×109/L)267.00(262.50,356.00)280.00(232.00,414.00)308.00(242.00,432.75)207.00(201.00,320.50)(1)(2)(3)11.0290.012
白蛋白(g/L)38.10(35.00,40.85)41.25(33.37,47.05)34.50(29.60,39.20)(1)(2)35.80(31.20,39.20)(2)11.6670.009
CA125(U/ml)24.15(14.26,52.12)29.53(19.41,57.95)69.10(40.94,185.40)(1)23.48(19.50,38.53)(3)16.3480.001
ESR(mm/h)25.00(10.00,59.00)41.00(25.00,68.25)46.00(14.5,85.00)13.00(13.00,31.50)6.2960.098
CRP(mg/L)12.24(1.84,40.51)6.34(1.67,29.85)24.22(6.3,91.30)12.66(3.05,82.20)5.2260.156
), ArticleFig(id=1203005084012601480, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979643453305574, language=CN, label=表2, caption=

各组肺结核患者血液生化指标比较[M(Q1，Q3)]

, figureFileSmall=null, figureFileBig=null, tableContent=
血液检测指标PTB组(n=186)BTB组(n=23)TBP组(n=42)DTB组(n=32)H(K)P
白细胞计数(×109/L)6.70(5.10,8.40)6.90(4.68,8.80)5.70(5.30,8.10)5.70(4.95,9.10)1.1470.766
淋巴细胞计数(×109/L)1.25(1.00,1.51)1.25(0.96,1.60)1.22(0.95,1.45)0.76(0.71,1.76)3.5500.314
血红蛋白(g/L)128.00(113.00,139.50)124.00(116.00,135.00)124.00(106.00,145.00)117.00(105.5,125.50)3.5860.310
血小板(×109/L)267.00(262.50,356.00)280.00(232.00,414.00)308.00(242.00,432.75)207.00(201.00,320.50)(1)(2)(3)11.0290.012
白蛋白(g/L)38.10(35.00,40.85)41.25(33.37,47.05)34.50(29.60,39.20)(1)(2)35.80(31.20,39.20)(2)11.6670.009
CA125(U/ml)24.15(14.26,52.12)29.53(19.41,57.95)69.10(40.94,185.40)(1)23.48(19.50,38.53)(3)16.3480.001
ESR(mm/h)25.00(10.00,59.00)41.00(25.00,68.25)46.00(14.5,85.00)13.00(13.00,31.50)6.2960.098
CRP(mg/L)12.24(1.84,40.51)6.34(1.67,29.85)24.22(6.3,91.30)12.66(3.05,82.20)5.2260.156
), ArticleFig(id=1203005084138430607, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979643453305574, language=EN, label=Tab. 3, caption=

Analysis on T cell subsets of tuberculosis patients in each group [M(Q1, Q3)]

, figureFileSmall=null, figureFileBig=null, tableContent=
T细胞分类PTB组(n=186)BTB组(n=23)TBP组(n=42)DTB组(n=32)H(K)P
T细胞计数(个/μl)1201.00(771.00,1463.00)1140.00(931.00,1301.00)1263.00(487.50,1499.50)866.00(488.5.00,1828.50)1.2330.745
T细胞百分比(%)71.58(66.89,76.87)76.75(69.60,78.35)74.27(64.17,80.87)70.40(68.80,80.15)1.9640.580
CD4+T计数(个/μl)692.00(400.00,800.00)710.50(478.00,786.00)633.00(251.00,933.00)611.00(301.50,973.00)0.7670.857
CD4+T细胞百分比(%)41.02(36.18,45.78)46.20(28.62,50.24)37.74(34.08,45.10)47.21(37.92,50.32)5.2050.157
CD8+T细胞计数(个/μl)430.00(276.00,564.50)325.00(230.25,455.00)330.00(165.00,675.00)236.00(150.00,640.50)3.4430.328
CD8+T百分比(%)26.16(21.49,31.91)21.80(18.32,35.54)27.36(20.05,37.52)26.32(18.4,35.81)1.0590.787
CD4+/CD8+T细胞比值1.61(1.18,2.03)1.70(1.43,2.32)1.52(1.05,2.15)1.50(1.06,2.86)3.0130.390
NK细胞计数(个/μl)176.00(99.50,290.50)164.50(95.50,335.25)160.00(55.00,221.00)70.00(33.50,218.50)(1)(2)9.0090.029
NK细胞百分比(%)12.38(8.77,17.27)9.80(4.10,17.54)8.28(5.44,15.72)(1)7.09(4.38,11.87)(1)9.8950.019
NKT细胞计数(个/μl)57.00(29.00,115.00)81.00(62.00,123.25)67.00(22.00,87.50)43.00(15.50,114.50)4.1820.242
NKT细胞百分比(%)4.38(2.78,6.02)4.60(3.57,8.92)3.34(2.80,5.60)3.76(2.14,7.94)2.7470.432
B细胞计数(个/μl)190.00(107.00,274.00)184.00(111.00,232.00)169.00(90.50,361.00)209.00(64.00,369.50)1.1300.770
B细胞百分比(%)12.70(9.57,16.82)11.35(6.18,12.80)12.96(9.36,20.95)(2)15.61(9.51,20.23)(2)8.3940.039
), ArticleFig(id=1203005084251676821, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1202979643453305574, language=CN, label=表3, caption=

各组肺结核患者T细胞亚群分析[M(Q1，Q3)]

, figureFileSmall=null, figureFileBig=null, tableContent=
T细胞分类PTB组(n=186)BTB组(n=23)TBP组(n=42)DTB组(n=32)H(K)P
T细胞计数(个/μl)1201.00(771.00,1463.00)1140.00(931.00,1301.00)1263.00(487.50,1499.50)866.00(488.5.00,1828.50)1.2330.745
T细胞百分比(%)71.58(66.89,76.87)76.75(69.60,78.35)74.27(64.17,80.87)70.40(68.80,80.15)1.9640.580
CD4+T计数(个/μl)692.00(400.00,800.00)710.50(478.00,786.00)633.00(251.00,933.00)611.00(301.50,973.00)0.7670.857
CD4+T细胞百分比(%)41.02(36.18,45.78)46.20(28.62,50.24)37.74(34.08,45.10)47.21(37.92,50.32)5.2050.157
CD8+T细胞计数(个/μl)430.00(276.00,564.50)325.00(230.25,455.00)330.00(165.00,675.00)236.00(150.00,640.50)3.4430.328
CD8+T百分比(%)26.16(21.49,31.91)21.80(18.32,35.54)27.36(20.05,37.52)26.32(18.4,35.81)1.0590.787
CD4+/CD8+T细胞比值1.61(1.18,2.03)1.70(1.43,2.32)1.52(1.05,2.15)1.50(1.06,2.86)3.0130.390
NK细胞计数(个/μl)176.00(99.50,290.50)164.50(95.50,335.25)160.00(55.00,221.00)70.00(33.50,218.50)(1)(2)9.0090.029
NK细胞百分比(%)12.38(8.77,17.27)9.80(4.10,17.54)8.28(5.44,15.72)(1)7.09(4.38,11.87)(1)9.8950.019
NKT细胞计数(个/μl)57.00(29.00,115.00)81.00(62.00,123.25)67.00(22.00,87.50)43.00(15.50,114.50)4.1820.242
NKT细胞百分比(%)4.38(2.78,6.02)4.60(3.57,8.92)3.34(2.80,5.60)3.76(2.14,7.94)2.7470.432
B细胞计数(个/μl)190.00(107.00,274.00)184.00(111.00,232.00)169.00(90.50,361.00)209.00(64.00,369.50)1.1300.770
B细胞百分比(%)12.70(9.57,16.82)11.35(6.18,12.80)12.96(9.36,20.95)(2)15.61(9.51,20.23)(2)8.3940.039
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不同类型肺结核患者T细胞亚群及血液学指标的差异研究
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俞珊 , 李志明 , 段浩凯 , 杨荔慧 , 何珂 , 许春霞 , 王涛 *
解放军医学杂志 | 结核病的预防、诊断与治疗专题研究Ⅱ 2023,48(7): 756-760
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解放军医学杂志 | 结核病的预防、诊断与治疗专题研究Ⅱ 2023, 48(7): 756-760
不同类型肺结核患者T细胞亚群及血液学指标的差异研究
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俞珊, 李志明, 段浩凯, 杨荔慧, 何珂, 许春霞, 王涛*
作者信息
  • 解放军总医院第八医学中心结核病医学部结核病科，北京 100091

    • 俞珊，博士研究生，主要从事中西医结合防治结核病的研究

通讯作者:

王涛，E-mail：
Variance analysis of T cell subsets and blood indicators in different types of pulmonary tuberculosis
Shan Yu, Zhi-Ming Li, Hao-Kai Duan, Li-Hui Yang, Ke He, Chun-Xia Xu, Tao Wang*
Affiliations
  • Department of Tuberculosis, Senior Department of Tuberculosis, the Eighth Medical Center of Chinese PLA General Hospital, Beijing 100091, China
出版时间: 2023-07-28 doi: 10.11855/j.issn.0577-7402.0994.2022.0715
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摘要
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目的 分析不同类型肺结核患者的病史、血液学指标及外周血淋巴细胞亚群的差异。方法 选取2018年1月－2021年12月解放军总医院第八医学中心结核病医学部结核病科收治的283例资料完整、诊断明确的初治、不耐药、无糖尿病的肺结核患者，分为继发性肺结核(PTB)组186例，气管、支气管结核(BTB)组23例，结核性胸膜炎(TBP)组42例及血行播散型肺结核(DTB)组32例，比较各组患者的一般资料、病史特点、血液检测指标及外周血淋巴细胞亚群的差异等。结果 PTB、BTB、TBP、DTB组患者的年龄、红细胞沉降率(ESR)、C-反应蛋白(CRP)、白细胞计数、淋巴细胞计数、血红蛋白水平比较差异均无统计学意义(P>0.05)。与其他组比较，BTB组男性比例(34.8%)及吸烟比例(8.8%)较低，病程较长(<3个月者占39.1%)，TBP组血小板计数[308.00(242.00，432.75.00)×109/L]及糖类抗原125[CA125，69.10(40.94，185.40) U/ml]水平较高，白蛋白[34.50(29.60，39.20) g/L]水平较低，病程较短(<3个月者占88.1%)，DTB组NK细胞计数[70.00(33.50，218.50)个/μl]及NK细胞百分比[7.09%(4.38%，11.87%)]较低，差异均有统计学意义(P<0.05)。结论 TBP患者中男性比例更高，BTB患者中女性比例更高，TBP患者的血小板计数及CA125水平更高，而DTB患者的NK细胞计数及百分比更低。

肺结核  /  血小板  /  白蛋白  /  糖类抗原125  /  T细胞亚群

Objective To determine the diversity between the different types of pulmonary tuberculosis, a retrospective analysis was made on the characteristics of medical history, blood indicators and the characteristics of peripheral T cell subsets of these patients. Methods The data of 283 pulmonary tuberculosis patients with full information were analyzed in the Eighth Medical Center of Chinese PLA General Hospital from January 2018 to December 2021, who had definite diagnosis, neither diabetes nor drug resistance, and were all on the initial treatment. The patients were divided into four groups: secondary pulmonary tuberculosis group (PTB group, 186 cases), tracheal and bronchial tuberculosis group (BTB group, 23 cases), tuberculous pleurisy group (TBP group, 42 cases) and hematogenous disseminated pulmonary tuberculosis group (DTB group, 32 cases). The patients' general conditions, medical history characteristics, laboratory indicators and T cell subsets, etc. were analyzed comparatively. Results There were no statistical differences in the age, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), leukocyte count, lymphocyte count and hemoglobin level of patients between PTB group, BTB group, TBP group and DTB group(P>0.05). Compared with other groups, the proportion of men (34.8%) and the smoking rate (8.8%) were lower, and the disease course was longer (only 39.1% for the patients less than 3 months) in BTB group (P<0.05); the platelet count [308.00(242.00, 432.75.00)×109/L] and carbohydrate antigen 125 (CA125) level [69.10(40.94, 185.40) U/ml] were higher, the albumin level[34.50(29.60, 39.20) g/L] was lower, and the disease course was shorter (88.1% for the patients less than 3 months) in TBP group;the NK cell count [70.00(33.50, 218.50) cells/μl] and NK cell percentage [7.09%(4.38%, 11.87%)] were lower in DTB group;the differences were statistically significant (P<0.05). Conclusions Male patients are more likely to suffer from TBP and female patients are more likely to suffer from BTB. Platelet counts and CA125 level are higher in patients with TBP, while the counts and proportion of NK cells are lower in patients with DTB.

pulmonary tuberculosis  /  platelets  /  albumin  /  carbohydrate antigen 125  /  T cell subsets
俞珊, 李志明, 段浩凯, 杨荔慧, 何珂, 许春霞, 王涛. 不同类型肺结核患者T细胞亚群及血液学指标的差异研究. 解放军医学杂志, 2023 , 48 (7) : 756 -760 . DOI: 10.11855/j.issn.0577-7402.0994.2022.0715
Shan Yu, Zhi-Ming Li, Hao-Kai Duan, Li-Hui Yang, Ke He, Chun-Xia Xu, Tao Wang. Variance analysis of T cell subsets and blood indicators in different types of pulmonary tuberculosis[J]. Medical Journal of Chinese People’s Liberation Army, 2023 , 48 (7) : 756 -760 . DOI: 10.11855/j.issn.0577-7402.0994.2022.0715
正文
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根据最新诊断标准，肺结核定义为发生在肺组织、气管、支气管及胸膜的结核[1]，包括肺实质结核，气管、支气管结核(bronchial tuberculosis，BTB)和结核性胸膜炎(tuberculous pleurisy，TBP)[2]，占各器官结核病总数的80%～90%，根据影像学及气管镜检查可分为原发性肺结核、血行播散型肺结核(hematogenous disseminated pulmonary tuberculosis，DTB)、继发性肺结核(secondary pulmonary tuberculosis，PTB)、BTB及TBP[3]。在肺结核中，BTB占6%～54%[4-5]，TBP占4.7%～17.6%[6-7]，粟粒性肺结核约占1%[8]，而原发性肺结核多见于青少年。本研究分析不同类型肺结核患者的病史、血液学指标及外周血淋巴细胞亚群方面的差异，并探讨其临床意义。
1 资料与方法
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1.1 一般资料
收集2018年1月－2021年12月解放军总医院第八医学中心结核病医学部结核病科收治的肺结核患者的临床资料进行回顾性分析。纳入标准：(1)年龄18～70岁；(2)符合2017年国家卫生和计划生育委员会发布的《肺结核诊断标准》[1]及《结核病分类标准》[2]，通过标本抗酸染色、分子生物学、标本培养或病理检查明确诊断的初治肺结核患者；(3)无心、肺、脑、肝、肾严重损伤；(4)无合并肿瘤；(5)人类免疫缺陷病毒(HIV)筛查阴性；(6)无长期大量使用激素或免疫抑制剂史。排除标准：(1)标本培养或分子生物学检测提示耐药结核；(2)标本培养或菌种鉴定为非结核分枝杆菌；(3)合并糖尿病；(4)既往有结核病史；(5)未收集到完整资料。本研究获解放军总医院第八医学中心伦理委员会批准(受理号309202205191130)。
1.2 检测方法
1.2.1 血常规、糖类抗原125(carbohydrate antigen 125，CA125)、红细胞沉降率(erythrocyte sedimentation rate，ESR)、C反应蛋白(C-reactive protein，CRP)检测
采用日本希森美康Xn-20全自动血细胞分析仪检测血常规，采用美国贝克曼库尔特UniCel DxI 800全自动化学发光免疫分析仪检测CA125，采用北京赛科希德SD-100检测仪检测ESR，采用美国贝克曼库尔特AU5800全自动生化分析仪检测CRP。
1.2.2 干扰素释放试验(interferon-gamma release assay，IGRA)
采用北京万泰生物药业股份有限公司生产的血IGRA检测试剂盒(体外释放酶联免疫吸附法)进行外周血IGRA检测。按照试剂盒说明书操作，每个测试分为“N-阴性孔”“T-检测孔”“P-阳性孔”3个孔。N孔检测体内基础γ干扰素(interferon-γ，IFN-γ)含量，T孔检测经结核分枝杆菌特异性抗原刺激全血后，被结核分枝杆菌感染的特异性T细胞释放的IFN-γ含量，P孔检测植物血凝素(phytohemagglutinin，PHA)非特异性刺激全血后T细胞释放的IFN-γ含量。结果判定标准：若T管与N管含量差值(T－N)≥14，并且≥N/4，则结果判定为阳性；若T－N<14，则结果判定为阴性。
1.2.3 结核分枝杆菌抗体检测
采用上海奥普生物医药有限公司提供的结核分枝杆菌抗体诊断试剂盒(胶体金法)检测结核抗体IgG。
1.2.4 T细胞亚群检测
采用美国贝克顿-迪金森公司提供的分选式流式细胞仪检测外周血T细胞、CD4+ T细胞、CD8+ T细胞、自然杀伤细胞(NK细胞)、自然杀伤T细胞(NKT细胞)、B细胞计数及百分比和CD4+/CD8+ T细胞比值(正常范围：T细胞计数966～2860个/μl，T细胞百分比0.50～0.84，CD4+ T细胞计数550～1440个/μl，CD4+ T细胞百分比0.27～0.51，CD8+ T细胞计数320～1250个/μl，CD8+ T细胞百分比0.15～0.44，NK细胞计数150～1100个/μl，NK细胞百分比0.07～0.14，NKT细胞计数40～300个/μl，NKT细胞百分比0.02～0.13，B细胞计数90～560个/μl，B细胞百分比0.05～0.18，CD4+/CD8+ T细胞比值0.71～2.78)。
1.3 统计学处理
采用SPSS 26.0软件进行统计分析。计数资料以例(%)表示，组间比较采用χ2检验；不符合正态分布的计量资料以M(Q1，Q3)表示，组间比较行Kruskal-Wallis秩和检验。P<0.05为差异有统计学意义。
2 结果
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2.1 各组肺结核患者一般资料比较
共纳入283例初治肺结核患者，其中男177例，女106例；年龄18～70(49.68±18.64)岁；PTB组186例，BTB组23例，TBP组42例，DTB组32例。各组患者的年龄、饮酒史比较差异无统计学意义(P>0.05)；TBP组男性最多，BTB组男性最少(P<0.05)；TBP组吸烟比例最高，BTB组吸烟比例最低(P<0.05)；TBP组病程最短，BTB组病程最长(P<0.05)；痰或肺泡灌洗液涂片检出抗酸杆菌阳性率BTB组最高，DTB组最低(P<0.05)；标本分子生物学阳性率进一步升高，BTB组可达100%，TBP组最低(P<0.05，表1)。
2.2 各组肺结核患者血生化检测结果分析
各组肺结核患者白细胞计数、淋巴细胞计数、淋巴细胞比例、血红蛋白、白蛋白、ESR、CRP比较差异均无统计学意义(P>0.05)；DTB组的血小板计数最低，BTB组的白蛋白水平最高，TBP组白蛋白水平最低(P<0.05)；TBP组的CA125水平最高，DTB组CA125水平最低(P<0.05，表2)。
2.3 各组肺结核患者IGRA检测及结核抗体阳性率比较
BTB、DTB、TBP、PTB组的IGRA阳性率分别为95.7%(22/23)、75.0%(24/32)、71.4%(30/42)、61.7%(113/186)，差异有统计学意义(χ2=13.073，P=0.004)。BTB、PTB、DTB、TBP组的结核抗体阳性率分别为73.9%(17/23)、68.8%(128/186)、53.1%(17/32)、52.4%(22/42)，差异无统计学意义(χ2=6.919，P=0.075)。
2.4 各组肺结核患者T细胞亚群分析
NK细胞计数BTB组的最高，DTB组最低，差异有统计学意义(P<0.05)；TBP组与DTB组的NK细胞百分比差异无统计学意义，均低于PTB组，且与BTB组比较差异无统计学意义；BTB组的B细胞百分比最低(P<0.05，表3)。
3 讨论
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由于原发性肺结核在儿童中较多见，而本院主要收治成年患者，因此将PTP、BTB、TBP及DTB患者纳入研究。本研究纳入的男性多于女性，男女比例约为5:3，其中TBP患者中男性比例最高，而BTB患者中女性比例最高。本研究中BTB患者占8.13%，TBP患者占14.84%，粟粒性肺结核占11.31%。考虑BTB症状较为隐匿，患者就诊比例低，因此纳入比例较低，而TBP及粟粒性肺结核患者症状较严重，住院比例较高，因此纳入比例略高。由于BTB症状不典型，极易延误诊断，因此BTB组病程超过3个月的患者比例最高，而TBP由于产生胸水压迫肺脏，引起胸闷、胸痛，因此易受到重视，TBP组病程小于1个月的患者比例超过1/2。女性支气管较窄，肺活量较低，咳嗽力量较小，同时由于女性对形象要求较高，怕咳嗽影响形象，容易抑制咳嗽，导致结核杆菌不易排出，因此女性容易合并BTB[5]。
既往研究表明，肺结核痰涂片检出抗酸杆菌的阳性率为28.1%～74.7%[9-10]。本研究中患者痰涂片检出抗酸杆菌的总阳性率为54.4%，而TBP组及DTB组涂片检出抗酸杆菌的阳性率不足12%。通过气管镜灌洗并采用聚合酶链反应(PCR)技术检测的标本阳性率明显提高[11]，其中BTB的标本阳性率可达100%，而TBP因病变主要在胸膜，因此阳性检出率最低。BTB组IGRA检测的阳性率最高，TBP组最低，与文献报道菌阳肺结核组的IGRA阳性率高于菌阴肺结核组的结果一致[12]。
研究发现，血小板除具有促进止血和凝血的功能，还能启动结核分枝杆菌的初始监测并促进随后的快速先天免疫反应[13]。血小板通过与细胞黏附分子的相互作用，以及操纵细胞内信号通路而影响细胞对结核分枝杆菌的响应[14]。CA125常以群体形式存在于胸膜、心包、腹膜、子宫内膜、生殖道及羊膜等间皮组织细胞表面，当结核分枝杆菌累及这些部位时，CA125水平明显升高[15]。本研究结果显示，TBP组患者的血小板计数及CA125水平在4组中均是最高的。
现代研究显示，血清白蛋白能够维持体内的胶体渗透压，与机体免疫力有关[16]。本研究结果显示，TBP患者的血清白蛋白水平最低，原因可能是由于大量白蛋白进入患者胸腔，从而导致血清白蛋白水平下降。
人体对结核分枝杆菌的免疫防御反应分为先天性免疫及适应性免疫。NK细胞是先天性免疫的主要参与者，T淋巴细胞是适应性免疫的代表[17-18]。本研究未发现4组患者的T细胞、CD4+ T细胞、CD8+ T细胞计数和百分比，以及CD4+/CD8+ T细胞比值存在明显差异，仅发现DTB组患者的NK细胞计数及百分比明显低于其他类型的肺结核患者。《结核病患者外周血淋巴细胞亚群检测及临床应用专家共识》[19]指出，结核病患者的NK细胞数量降低，自然杀伤力下降，且病情越重，下降越明显。本研究发现，DTB组患者的NK细胞计数及百分比最低，表明其病情最重。B淋巴细胞主要执行抗结核的体液免疫功能[20]。本研究结果显示，DTB组患者B细胞百分比明显高于其他类型肺结核患者，而B细胞计数差异无统计学意义，原因可能与其他类型T细胞减少导致的B淋巴细胞比例升高有关。
综上所述，本研究结果显示男性更易患TBP，就诊较早；女性更易患BTB，就诊较晚；TBP患者的血小板计数及CA125水平更高，更易出现白蛋白水平下降，而DTB患者的NK细胞计数及百分比更低。但这些指标的差异与预后的关系有待进一步研究。
基金
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  • 国家自然科学基金面上项目(82072233)
文献
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参考文献 引证文献
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2023年第48卷第7期
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doi: 10.11855/j.issn.0577-7402.0994.2022.0715
  • 接收时间：2022-04-28
  • 首发时间：2025-12-03
  • 出版时间：2023-07-28
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  • 收稿日期：2022-04-28
  • 录用日期：2022-06-09
基金
National Natural Science Foundation of China(82072233)
国家自然科学基金面上项目(82072233)
作者信息
    解放军总医院第八医学中心结核病医学部结核病科，北京 100091

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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