结核性及恶性肿瘤性胸腔积液淋巴细胞亚群比例以及Th1/Th2免疫平衡研究

凡瞿明; 张国元; 刘剑平; 严明生; 刘彦华; 唐中; 何兰

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结核性及恶性肿瘤性胸腔积液淋巴细胞亚群比例以及Th1/Th2免疫平衡研究

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- 结核性及恶性肿瘤性胸腔积液淋巴细胞亚群比例以及Th1/Th2免疫平衡研究
- Proportion of leukomonocyte subgroup and T-helper type 1/T-helper type 2 balance in tuberculous pleural effusion and malignant pleural effusion
- 陆军军医大学学报 2008年30卷第18期页码：1749-1752
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  中图分类号： R392.3;R520.2;R561.302
- 纸质出版：2008
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凡瞿明,张国元,刘剑平,严明生,刘彦华,唐中,何兰.结核性及恶性肿瘤性胸腔积液淋巴细胞亚群比例以及Th1/Th2免疫平衡研究[J].陆军军医大学学报(原第三军医大学学报),2008,30(18):1749-1752.

　FAN Qu-ming,ZHANG Guo-yuan,LIU Jian-ping,YAN Ming-sheng,LIU Yan-hua,TANG Zhong,HE Lan.Proportion of leukomonocyte subgroup and T-helper type 1/T-helper type 2 balance in tuberculous pleural effusion and malignant pleural effusion[J].J Amry Med Univ (J Third Mil Med Univ),2008,30(18):1749-1752.
凡瞿明,张国元,刘剑平,严明生,刘彦华,唐中,何兰.结核性及恶性肿瘤性胸腔积液淋巴细胞亚群比例以及Th1/Th2免疫平衡研究[J].陆军军医大学学报(原第三军医大学学报),2008,30(18):1749-1752. DOI：

　FAN Qu-ming,ZHANG Guo-yuan,LIU Jian-ping,YAN Ming-sheng,LIU Yan-hua,TANG Zhong,HE Lan.Proportion of leukomonocyte subgroup and T-helper type 1/T-helper type 2 balance in tuberculous pleural effusion and malignant pleural effusion[J].J Amry Med Univ (J Third Mil Med Univ),2008,30(18):1749-1752. DOI：

摘要

目的探讨Th1/Th2免疫应答平衡在结核性和恶性肿瘤性胸腔积液病理生理过程中的可能作用。方法对24例治疗前结核性胸腔积液以及28例患者恶性胸腔积液患者胸液标本进行有核细胞计数、分类和流式细胞仪检测淋巴细胞亚群，检测CD3

CD3

CD4

、CD3

CD8

T淋巴细胞亚群比例，并计算CD4

/CD8

值；利用夹心酶联免疫吸附测定(ELISA)法检测胸液标本中INF-γ、IL-18、TNF-α以及IL-10的浓度。结果结核性胸腔积液患者胸水中T辅助淋巴细胞以CD3

CD4

细胞为主，其CD3

细胞比例、CD3

CD4

细胞比例以及CD4

/CD8

值均高于恶性肿瘤性胸腔积液组（P0.01）。2组研究对象INF-γ、IL-18、TNF-α以及IL-10的浓度分别是(中位数)：结核性胸腔积液组942.0、1 526、62 pg/ml和153 pg/ml；恶性胸腔积液组10.35、1 763、8.85 pg/ml和66.85 pg/ml。结核性胸腔积液中INF-γ、TNF-α以及IL-10均明显高于恶性肿瘤性胸腔积液中的水平（P0.01），且平均分别高约90倍、7倍和2倍。IL-18在2组胸腔积液中的含量无显著性差异（P0.05）。结核性胸腔积液IL-18/IL-10明显低于恶性肿瘤性胸腔积液组（P0.01）。结论结核性胸腔积液表现为Th1免疫应答为主；而恶性肿瘤性胸腔积液患者存在明显的细胞免疫功能低下。这种低下可能主要以T辅助淋巴细胞受损、Thl免疫应答降低以及Th2免疫应答升高为主。IFN-γ可作为鉴别结核性胸腔积液和恶性肿瘤性胸腔积液特异性和敏感度较高的指标。

Abstract

Objective To investigate the possible role of T-helper type 1/T-helper type 2 balance in the pathogenesis of human tuberculous and malignant pleuris

y by examining the proportion of T leukomonocyte subgroup: CD3

CD3

CD4

CD3

CD8

and evaluating the distribution features of Th1-type cytokines (INF-γ

IL-18 and TNF-α) and Th2-type cytokine (IL-10) in tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE). Methods Twenty-four samples of tuberculous pleural effusion and 28 samples of malignant pleural effusion were collected and detected the karyocyte cell counting

classification

proportion of T leukomonocyte subgroup CD3

CD3

CD4

CD3

CD8

and the ratio of CD4

/CD8

. Simultaneously

the concentrations of INF-γ

IL-18

TNF-α and IL-10 were measured with ELISA before treatment. Results The proportion of CD3

CD3

CD4

or CD4

/CD8

in TPE was significantly higher than that in MPE. The median concentrations of INF-γ

IL-18

TNF-α and IL-10 in pleural effusion were 942.0

1 526

62 pg/ml and 153 pg/ml in TPE

and 10.35

1 763

8.85 pg/ml and 66.85 pg/ml in MPE respectively. The levels of INF-γ

TNF-α and IL-10 in TPE were significantly higher (about 90-fold

7-fold and 2-fold respectively) than that in MPE (P0.01). However

no significant difference of IL-18 was found between the two kinds of pleural effusions (P0.05). The ratio of IL-18 to IL-10 in TPE was markedly lower than that in MPE (P0.01). Conclusion Tuberculous pleural effusion presents a process with Th1-dominant pathogenesis. Malignant pleural effusion presents impaired T help leukomonocytes

Th2-dominant pathogenesis and depressed Th1 immune response

which may contribute to the low cellular immunity in the patients with malignant pleural effusion. INF-γ might be an available indicator to distinguish tuberculous pleural effusion from malignant pleural effusion with high specificity and sensitivity.

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