| Objective:By studying the influence of sleep disorders and staying up late on the peripheral blood immune indexes of patients with pulmonary tuberculosis(PTB)to provide basis for sleep disorders and staying up late as risk factors of pulmonary tuberculosis from the mechanism level;and also to provide theoretical basis for clinicians to pay attention to the influence of sleep disorders and staying up late on diseases in the process of diagnosis and treatment of pulmonary tuberculosis in the future,then to strengthen immunomodulatory treatment in combination;at the same time,to provide theoretical basis for patients that they should pay attention to sleep behavior in the future,actively correct bad habits of work and rest,and treat sleep disorders as early as possible.Methods:All of the 141 newly treated PTB patients were in line with the new version of the people’s Republic of China health industry standard PTB diagnosis issued by the national health and Family Planning Commission on November 9,2017 and implemented on May1,2018.Pittsburgh Sleep Quality Index(PSQI)investigation and evaluation were carried out for each patient,and the sleep time,length of sleep and frequency of staying up late every week of all PTB patients were investigated.According to PSQI score,they were divided into sleep disorder group and no sleep disorder group.According to the sleeping time,PTB patients in the non sleep disorder group were divided into two groups: staying up late group and non staying up late group.The data of sex,age,body mass index,sputum smear,chest CT imaging(whether there is cavity or not,the number of lobes involved in the lesion),Albumin,Prealbumin and peripheral blood immune indexes(CD3 +,CD4 +,CD8 +,CD4 + / CD8 +,B cells,NK cells)were collected.1.To analyzethe influence of sleep disorder on the immune indexes of PTB patients 1.1 to compare the changes of immune indexes between sleep disorder group and non sleep disorder group;1.2 to compare the changes of immune indexes in peripheral blood of PTB patients with different degrees of sleep disorder group;1.3 to further compare the immune indexes between the three groups in pairs;2.To analyze the influence of staying up late on the immune indexes of PTB patients 2.1 To compare the difference of the immune indexes between the staying up group and the non staying up group;2.2 To compare the difference of the immune indexes in the peripheral blood of PTB patients with different staying up frequency by taking the staying up frequency of 3 times/week as the boundary value;3.To analyze the influence of sleep duration on the immune function of PTB patients,3.1 To evaluate the correlation between sleep duration and immune indexes;3.2To compare the differences of immune indexes among the three groups that the non sleep disorder group was divided into three groups according to the length of sleep: 6 h,6-7 h and 7 h;3.3 the indexes with significant differences were compared in pairs.Results:141 patients with PTB,73 patients with sleep disorder and 68 patients without sleep disorder,73 patients with sleep disorder were divided into three groups according to the PSQI survey score: mild,moderate and severe,31 patients with mild,25 patients with moderate and 17 patients with severe;according to whether their sleep time at night exceeds 23 hours and ≥1 time / week,they were divided into stay up late group and non stay up late group,35 patients in stay up late group and 33 patients in non stay up late group.There was no significant difference between the sleep disorder group and the non sleep disorder group,and between the stay up late group and the non stay up late group in the baseline data: gender,age,condition and nutrition(P>0.05).The two sets of data are comparable.1.Sleep disorder:1.1 compared with the non sleep disorder group,the levels of all immune indexes in the sleep disorder group were lower except for the increase of CD8%(P < 0.05).1.2 the levels of peripheral blood immune indexes in different degree of sleep disorder group were different(P<0.05).With the aggravation of sleep disorder,theaverage levels of CD3+,CD4+,CD4+/CD8+ and NK cells in peripheral blood decreased gradually,and the level of CD8+ increased;the average level of B cells in moderate and severe sleep disorder group was lower than that in mild sleep disorder group,The mean level of B cells in severe sleep disorder group was slightly higher than that in moderate sleep disorder group(P<0.05).1.3 the results showed that(1)there was no difference in NK cell level between mild and moderate sleep disorders(P>0.05),the other immune indexes were statistically different(P<0.05);(2)there was no difference in B cell level between moderate and severe sleep disorders(P>0.05),the other immune indexes were statistically different(P<0.05);(3)There were significant differences in the levels of all immune indexes between mild and severe sleep disorder groups(P<0.05).2.Staying up late: 2.1 except for the increase of CD8 +,the other immune indexes of PTB patients in the staying up late group were lower than those in the non staying up late group,There was no difference between the two groups except for the level of B cell and NK cell(P<0.05).2.2 according to whether the staying up late frequency is more than 3 times / week,35 patients in the staying up late group were divided into two groups.Except that the level of CD8+ index in the staying up late frequency>3 time/week group is higher than that in the staying up late frequency≤3 times/week group,the level of other immune indexes is lower than that in the staying up late frequency≤3 times/week group.Except that there is no difference in the level of CD3+ and B cells between the two groups(P>0.05),the other immune indexes were statistically different(P<0.05).3.Sleep duration: 3.1 analyze the correlation between sleep duration at night and immune indexes.The statistical results showed that: sleep duration was positively correlated with CD4+,CD4 +/CD8+,NK cell level,Pearson correlation coefficient was0.37,0.36,0.32 respectively;sleep duration was negatively correlated with CD8+ index level,Pearson correlation coefficient was:-0.28;there was statistical difference(P<0.05).There was no correlation between sleep duration and CD3+ and B cell indexes.3.2 single factor analysis of variance showed that there was no significant difference among the three groups in the three indexes of CD3+,CD8+,B cell,but there was significant difference among the three indexes of CD4+,CD4+/CD8+,NK cell(P<0.05).3.3 thethree indexes of CD4+,CD4+/CD8+,NK cells were compared between the three groups:(1)the sleep time < 6h group compared with the 6-7h group,except for the difference of NK cell level(P<0.05),there was no difference in CD4+,CD4+/CD8 +;(2)the group >7h compared with the 6-7h group,there was no difference in NK cell level,but there was statistical difference in CD4+,CD4+/CD8+(P<0.05);(3)Compared with the sleep time< 6h group and > 7h group,the levels of the three indexes were different(P<0.05).Conclusion:Sleep disorders and staying up late had negative effects on cellular immunity,innate immunity and humoral immunity of PTB patients to some extent,and they were related to the severity of sleep disorders,the frequency of staying up late and the length of sleep at night,which provided opportunities for the reinfection of MTB and the aggravation of the disease.The specific impacts were as follows:1.Sleep disorders had negative influence on the humoral immune,cellular immune and innate immune functions of PTB patients.2.Sleep disorders of different degrees had different effects on the immune function of PTB patients,as the degree of sleep disorders was aggravating,the damage to the immune function was aggravating too.3.Staying up late had negative effect on cellular immunity of PTB patients.;It hah no effect on humoral immunity and innate immunity.However,with the increase of the frequency of staying up late(>3 times/week),it could also affect the innate immunity and increased the damage of cellular immunity.4.Sleep duration was positively correlated with cellular immunity and innate immunity of PTB patients.When sleep duration was less than 6h,the damage of above immunity were more obvious;It had been proved that sleep duration had no correlation with humoral immunity. |
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