Dynamic Changes And Its Clinical Significance Of T Cells And Related Cytokines In Patients With Pulmonary Tuberculosis

Objective To investigate the dynamic changes and its clinical significance of T cells and related cytokines in tuberculosis patients before and after treatment by detecting pulmonary tuberculosis and healthy adults peripheral blood T cells and related cytokines.Material and Methods1. Clinical trail group:The study included53initial treatment secondary tuberculosis inpatients who admitted to ZHUZHOU Central Hospital from November2012to April2013, whose diagnosis was confirmed according to the criteria of 《Guidelines for Diagnosis and Treatment of Pulmonary Tuberculosis》.The patients (26females and27males) ranged in age from18to72years with a mean age of41.34±16.36years. Pulmonary disease was classified into two groups according to the extent and type of disease as assessed by CT-scan:focus limited group (n=22) patients presenting unilateral or bilateral involvement of two or less lobes; focus diffuse group (n=31) with unilateral or bilateral involvement of more than two lobes. All patients did not complicated with diabetes mellitus, abnormal function of the liver and kidney, malignant tumor, hyperthyroidism or any autoimmune disease. All patients had never taken any immunomodulator before antituberculosis therapy. In the CT-scan after two months of anti-TB treatment, the reduction of the lesion area with50%or more of the basic area before therapy was showed in25patients(absorption group), whereas, the reduction of the lesion area with less than50%of the basic area was showed in28patients(lesion malabsorption group).2.Control group:The study recruited20healthy adults as control group,which included10males and10females (mean age37.95±16.36), ranged from22to68years old.Methods1.CD3+T、CD4+T、CD8+T cells ratio in the peripheral blood of all the cases is measured by fluorescently-labeled monoclonal antibody with flow cytometry, and IL-2、IL-10、IFN-γ and TNF-α in serum of the patient is detected with ELISA (enzyme linked immunosorbent assay) methods of double-antibody sandwich. After two months (isoniazide+rifampin+pyrazinamide+ethambutol) intensive chemotherapy, CD3+T、CD4+T、CD8+T cells ratio and IL-2、IL-10、IFN-γ and TNF-α were measured again in clinical group.Statistical methodThe measurement datas were indicated in standard deviation (x±s), which compared by t test. Meanwhile the measurement datas of before and after treatment were compared with paire t test.The test level was0.05. All datas were processed by statistical software of SPSS16.0.Results(1) Comparing with healthy adults, TB patients’peripheral blood CD4+T cells and CD4+/CD8+ratio decreased significantly before treatment (P<0.05),and CD4+T cells and CD4+/CD8+ratio was significantly increased after treatment (P<0.05), no difference with the normal (P>0.05). TB patients’ peripheral blood CD3+T cells were lower than healthy adults, and CD8+T cells were higher than healthy adults, but no statistical significance (p>0.05). and CD4+/CD8+ratio decreased significantly before treatment (P<0.05),and CD4+T cells and CD4+/CD8+ratio was significantly increased after treatment comparing with healthy adults,TB patients’serum IFN-γ level declined significantly before treatment (p<0.05), serum IL-10, TNF-α increased significantly (p<0.05)。After the treatment, serum IFN-y significantly increased (p<0.05), but it’s still not return to normal(p<0.05),and IL-10、TNF-α dropped significantly (p<0.05), that with no difference to healthy adults. TB patients’serum IL-2level was higher than healthy adults, but no statistical significance (p>0.05).(2) Peripheral blood CD4+T cells, CD4+/CD8+ratio and serum IFN-y level of focus diffuse group were lower than focus limited group before treatment, which the serum TNF-a concentrations were much higher. There was significant difference between the two groups (P<0.05). There was no statistical difference between the two groups of peripheral blood CD3+T cells, CD8+T cells, serum IL-2, IL-10level (p>0.05).(3) There were no obvious statistical difference in peripheral blood CD3+T, CD4+T, CD8+T cells, CD4+/CD8+ratio and the levels of serum IFN-γ, TNF-α, IL-2, IL-10concentration between absorption group and lesion malabsorption group before treatment. Peripheral blood CD4+T cells, CD4+/CD8+ratio, serum IFN-y, IL-10, TNF-α levels of absorption group restored normal after treatment,and which were no statistical difference comparing with control group (P>0.05). CD4+/CD8+ratio, serum IL-10, TNF-α levels of the lesion malabsorption group returned to normal after treatment, howerer peripheral blood serum levels of CD4+T, IFN-y still did not return to normal (P<0.05).Conclusion1.Cellular immune function in patients with pulmonary tuberculosis is impaired, characterized by CD4+T cells、CD4+/CD8+ratio drops, enhancing immunity cytokines IFN-γ drop significantly, and a marked increase in the inflammatory factor TNF-α, inhibitory factor of IL-10increase significantly. After strengthened anti-tuberculosis treatment, CD4+T cells、CD4+/CD8+ratio and IFN-γ increase significantly, meanwhile TNF-α, IL-10decline significantly. 2. The severity of pulmonary tuberculosis patients is related with the degree of impaired immune function.3. CD4+T lymphocytes and Thl-type cytokines play an important role in the prevention of tuberculosis.