Dynamic Observation Of T Lymphocyte Subpopulations, S IL-2R And TNF-α Of Patients With Active Pulmonary Tuberculosis In Different Age Group

Objective: According to the reports, the infection rate of mycobacteriumtuberculosis is still very high all over the world. The immune system plays animportant role in the pathogenesis, development and outcome of tuberculosis,which affect the prognosis of patients directly.There are some differences in pathogenesis and outcome of patients indifferent age with active pulmonary tuberculosis, especially in elderly patients.Even with the same chemotherapy, the pathogenesis and outcome of patientswith active pulmonary tuberculosis in different age are different because ofthe differences between the bodys’ immune function. Currently, it have beenattached great importance to immunotherapy in patients with pulmonarytuberculosis both here and abroad. But the analysis of the immune system andcytokines in different ages of patients, especially in the elderly is less.In the adjuvant therapy of tuberculosis, IL-2 can improve the immunityand also inhibit the growth process of bacteria. The combination of solubleinterleukin-2 receptor(s IL-2R) and IL-2 could lead to the impairment ofimmune function, and then the infection is difficult to control and form avicious spiral. The s IL-2R can be a negative index to the immunity in patientswith pulmonary tuberculosis. Tumor necrosis factor-α(TNF-α) is one of themonokines and also involves in the regulation of immune response. Moderateamounts of TNF-α can protect the body, but it can also result in tissue damagethrough the induction of allergic reaction when it is over-expressed.Through the dynamic observation of T lymphocyte subpopulations,s IL-2R and TNF-α of patients with active pulmonary tuberculosis in differentage and on different stages of the treatment, we can investigate theimmunological characteristics of elderly patients, and then it can help toimprove the therapy.Methods: 80 patients with secondary pulmonary tuberculosis in ChestHospital of Hebei Province from 2013 June to 2014 June were divided into Agroup(younger than 60 years old,40 cases) and B group(older than 60 yearsold,40 cases). Those patients who have immune system disease, combinedwith other system infection, treated with immunosuppressant or immunemodulators, had treatment of anti-tuberculosis, with serious adverse reactionsduring treatment or incompliance were excluded. All patients received2HRZE/4HR anti-tuberculosis treatment under complete supervision. In threedifferent periods [Before the treatment(T0), 1 months(T1), 6 months(T6) ],the changes of the clinical symptoms(cough, sputum, fever, fatigue, nightsweats, haemoptysis, etc) were observed. It is effective when the symptomsabove become better gradually until they disappears. Clinical efficiency wasused to describe the improvement of symptoms. When Sputum smear turnnegative, bacteriological observation index is effective. The effective rate oftreatment was associated with the decrease of lesions shown on the Chest CTimages. When the lesions decreased more than 1/2, it was defined as grade A.And grade B, C and D were defined respectively when the lesions decreasedbetween 1/5 to 1/2, decreased less than 1/5 and increased. The effective rateof treatment is equal to(patients of grade A + patients of grade B) / 40×100%. T lymphocyte subpopulations of venous blood were analyzed, and theconcentrations of s IL-2R、TNF-α in serums were also detected.Results:1 Clinical analysisIn period of T0, there were no significant differences in clinicalmanifestations(symptoms, sputum acid-fast bacteria stains, image performan-ces) of the patients in the two groups. Symptoms: In period of T0, the clinicalsymptoms of 21 patients in A group disappeared,at the same time the clinicalsymptoms of 11 patients in B group also disappeared. But the effective rate ofA group was higher than that of B group(52.50% vs 27.50%, P<0.05). Inperiod of T6 the clinical symptoms of 32 patients of A group disappeared,atthe same time the clinical symptoms of 25 patients in B group disappeared. Inthe period of T6, the difference of effective rates between two groups had nostatistical significance(P>0.05)(Table 1). Sputum acid-fast bacteria stains:sputum smear negative conversion rate of A group was higher than that of Bgroup in the period of T1(72.50% vs 37.50%, P < 0.05). In the period of T6,the difference of sputum smear negative conversion rates between two groupshad no statistical significance(P>0.05)(Table 2). Image performances:The image performances of A group in period of T6 perform was better thanthat in period of T1. The effective rates(patients of grade A + patients ofgrade B) of the two period have significant differences(92.50% vs 65.00%,P<0.01)(Table 3). The image performances of B group in period of T6 perform was better than that in period of T1. The effective rates(patients ofgrade A + patients of grade B) of the two period had significant differences(82.50% vs 32.50%, P<0.01)(Table 4). The effective rates of A group inperiod of T1 was better than that of group B(65.00% vs 32.50%, P<0.01)(Table 5 、 Fig.1, 2). In the period of T6, the difference of effective ratesbetween two groups had no statistical significance(P>0.05)(Table 6、Fig.3).2 Analysis of T cell subsetsT cells(CD3+ cells): In period of T0、T1 and T6, numbers of CD3+ cellsof A group were higher than those of B group [( 60.49±4.10) % vs(54.50±6.44) %,(70.14±5.13)% vs(59.54±7.00)%,(69.21±5.37)%vs(60.52±4.16)%, all P<0.05](Table 7).Th cells(CD3+CD4+CD8- cells): In the period of T0、T1 and T6,numbers of CD3+CD4+CD8- cells of A group was higher than that of the Bgroup [( 41.90±5.12) % vs( 32.75±7.57) %,( 48.93±6.70) % vs(36.77±4.84)%,(45.25±6.71)% vs(37.37±5.63)%, all P<0.05](Table8).Ts cells(CD3+CD4-CD8+ cells): In the period of T0、T1 and T6, therewas no differences of the numbers of CD3+CD4-CD8+ cells between thetwo groups(P>0.05)(Table 9).Th/Ts(CD4+/CD8+): In the period of T0, the CD4+/CD8+ value of Agroup was higher than that of the B group [(1.63±0.32)vs(1.19±0.46), P<0.05]. There were no differences of the CD4+/CD8+ value between the twogroups both in the period of T1 and T6,(both P>0.05)(Table 10).3 The level of s IL-2R in serumIn period of T0, the s IL-2R level of group B was higher than that ofgroup A [(198.21±25.56) pmol/L vs(159.63±33.79) pmol/L, P < 0.05]. Inperiod of T1, the s IL-2R level of group B was still higher than that of groupA [(169.37±26.72) pmol/L vs(107.85±25.77)pmol/L,P<0.05]. Therewere no significant differences of s IL-2R level between the two groups inperiod of T6(P > 0.05)(Table 11).4 The level of TNF-α in serumThere was no significant differences of TNF-α level between the twogroups in period of T0 [(68.45±19.05) ng/L vs(75.92±21.42) ng/L, P >0.05]. In period of T1, the TNF-α level of B group was higher than that ofgroup A [(69.32 + 8.57) ng/L vs(53.45 + 14.35) ng/L, P < 0.05]. In period ofT6, the difference of TNF-α level between two groups had no statisticallysignificant(P > 0.05).Conclusions:The immune function of T lymphocytes of senior patientswith secondary pulmonary tuberculosis is lower than that of younger patients.The recovery of s IL-2R and TNF-a levels in the course of treatment is alsoslower in senior patients. All of these may affect the treatment and the curetime of senior patients with pulmonary tuberculosis.