不同程度肺部受累的单纯肺结核患者免疫内分泌失衡特征分析

doi:10.19871/j.cnki.xfcrbzz.2025.03.002

摘要/Abstract

摘要： 目的分析不同程度肺部受累肺结核（pulmonary tuberculosis,PTB）患者的免疫内分泌介质表达差异,探究免疫内分泌介质对PTB患者的临床应用价值。方法纳入2021年1月至2023年11月期间于陕西省结核病防治院就诊的130例首次诊断成人PTB患者（PTB组）,另纳入130例健康志愿者（对照组）。所有PTB组患者均根据影像学病变的范围和类型将肺部受累程度分为轻度、中度及重度。所有参与者在入组时均采集血液样本（上午8点采集）,检测参与者的血浆瘦素、白介素-6（interleukin-6,IL-6）、皮质醇、脱氢表雄酮（dehydroepiandrosterone,DHEA）、C反应蛋白（C-reactive protein,CRP）水平,并分析参与者的体外免疫反应[淋巴细胞增殖和γ干扰素（interferon-γ,IFN-γ）产生]。结果 PTB组患者瘦素和DHEA水平低于对照组,CRP、IL-6、皮质醇水平及皮质醇/DHEA比值高于对照组（均P<0.001）。重度PTB患者瘦素水平低于轻度和中度PTB患者,DHEA水平低于轻度PTB患者,CRP、IL-6、皮质醇/DHEA高于轻度和中度PTB患者,皮质醇水平高于轻度PTB患者（均P<0.001）。在PTB组中,体重指数（body mass index,BMI）与瘦素呈正相关。对照组和PTB组患者体外结核分枝杆菌诱导的淋巴细胞增殖和IFN-γ产生存在显著差异,尤其在重度肺部受累的PTB患者中淋巴细胞增殖和IFN-γ产生明显更低,且瘦素与PTB患者外周血单个核细胞培养上清液中的IFN-γ及刀豆蛋白A诱导的淋巴细胞增殖呈正相关。通过BMI及免疫内分泌介质判别分析建立了2个PTB患者肺部受累程度判别函数,判别函数1能解释方差变异的90.00%,而判别函数2只有10.00%,2个判别函数均有判别意义（均P<0.001）,判别函数组质心没有重叠,可以清楚地将PTB患者的不同程度肺部受累区分开来。结论 PTB患者存在免疫内分泌失衡,且免疫内分泌失衡可能导致患者的肺部受累加重。

关键词: 肺结核, 免疫, 内分泌, 肺部受累

Abstract: Objective To analyze the differential expression of immune endocrine mediators in patients with pulmonary tuberculosis (PTB) with different degrees of lung involvement, and evaluate the relationship between immune endocrine mediators and in vitro immune response. Method From January 2021 to November 2023, 130 newly diagnosed adult PTB patients aged 18 to 65 years were enrolled in the PTB group,and 130 volunteers were recruited as the control group. All patients were classified into mild, moderate, and severe lung involvement according to the extent and type of radiological lesions. Blood samples were collected from all participants at 8:00 AM upon enrollment to measure their plasma levels of leptin, interleukin-6 (IL-6), cortisol, dehydroepiandrosterone (DHEA), and C-reactive protein (CRP), and to analyze their in vitro immune responses, including lymphocyte proliferation and interferon-γ (IFN-γ) production. Result The levels of leptin and DHEA in the PTB group were lower than those in the control group, CRP, IL-6, Cortisol levels and cortisol/DHEA ratio were higher than those in the control group (P<0.001). Further pairwise comparisons showed that the severe subgroup had lower leptin levels than the mild and moderate subgroups, lower DHEA levels than the mild subgroup, higher CRP, IL-6 and cortisol/DHEA levels than the mild and moderate subgroups, and higher cortisol levels than the mild subgroup (P< 0.001). Body mass index (BMI) was positively correlated with leptin in PTB group. Two discriminant functions of lung involvement in PTB patients were established by discriminant analysis of BMI and immunoendocrine mediators. There were significant differences in in vitro Mycobacterium tuberculosis-induced lymphocyte proliferation and IFN-γ production between control group and PTB group, especially in PTB patients with severe lung involvement, lymphocyte proliferation and IFN-γ production were significantly lower, and IFN-γ in the culture supernatant of leptin and PTB patients was positively correlated with concanavalin A-induced lymphocyte proliferation. Discriminant function 1 could explain 90.00% of the variance variation, while discriminant function 2 was only 10.00%. Both discriminant functions had significance difference (P<0.001), and the group centroid of discriminant functions did not overlap. The degree of lung involvement in PTB patients can be clearly distinguished. Conclusion There is immune-endocrine imbalance in patients with PTB, which may lead to increased lung involvement.

Key words: Pulmonary tuberculosis, Immune, Endocrine, Lung involvement

中图分类号:

R521

张权武, 王婉如, 卢琼, 辛超. 不同程度肺部受累的单纯肺结核患者免疫内分泌失衡特征分析[J]. 新发传染病电子杂志, 2025, 10(3): 6-11.

Zhang Quanwu, Wang Wanru, Lu Qiong, Xin Chao. Characteristics of immune-endocrine imbalance in uncomplicated pulmonary tuberculosis patients with different degrees of lung involvement[J]. Electronic Journal of Emerging Infectious Diseases, 2025, 10(3): 6-11.

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