Changes And Significance Of T Lymphocyte Subsets In Peripheral Blood In Patients With Tuberculosis,Diabetes And Pneumonia

Objective:To detect the number of CD3~+,CD4~+,CD8~+T lymphocytes in peripheral blood of patients with tuberculosis,type 2 diabetes mellitus,ordinary bacterial pneumonia and healthy people,and to compare and analyse the number of these cells:Whether these cells are related to the pathogenesis of tuberculosis and severity of disease;Whether these cells are related to the mechanism of diabetes complicated with tuberculosis;whether it can provide clues for the differential diagnosis of tuberculosis and ordinary bacterial pneumonia.Methods:(1)According to inclusion criteria and exclusion criteria,the subjects were screened:(1)Totally 223 patients with tuberculosis Hospitalized in Affiliated Hospital of North Sichuan Medical College from December 2010 to April 2017 were selected as TB group.According to whether the merger of type 2 diabetes mellitus or bacterial pneumonia,TB group were divided into:simple tuberculosis(S-TB)group(n=123),tuberculosis with diabetes(TB-DM)group(n=16),tuberculosis with bacterial pneumonia(TB-BP)group(n=71),tuberculosis with pneumonia and diabetes(TB-BP-DM)group(n=13);according to whether the merger of extrapulmonary tuberculosis,S-TB were divided into:simple pulmonary tuberculosis(PTB)group(n=57);pulmonary tuberculosis complicated with extrapulmonary tuberculosis(PTB-ex)group(n=66).(2)Select healthy people from medical centerin the hospital during the same period as the healthy control(HC)group(n=112).(3)Select patients with simple ordinary bacterial pneumonia as the bacterial pneumonia(BP)group(n=35).(4)Select patients with simple type 2 diabetes mellitus,as the diabetes mellitus(DM)group(n=50).(2)(1)Collect the clinical information of the above groups.(2)Collected peripheral blood of each group.Flow cytometry was used to detect the numbers of CD3~+,CD4~+,CD8~+T lymphocytes and CD4/CD8Ratio in peripheral blood of each experimental group.(3)For TB group,according to whether the patients had fever or emaciation,pulmonary cavity,caseous necrosis,extrapulmonary tuberculosis and involved lung field range to calculate the score.According to the total score,TB group were divided into mild,moderate,severe and extremely severe 4 groups.(4)Data were analyzed using the Statistical Package for Social Scientists(SPSS),using independent samples t-test and one-way ANOVA or non-parametric test for statistical analysis.Results:(1)There was no significant difference in the distributions of CD3~+,CD4~+,CD8~+T counts and CD4/CD8 ratios between the different sexes and age groups in the HC,TB,BP and DM group(p>0.05).(2)The number of T lymphocyte subsets in peripheral blood in HC group and S-TB group:The number of CD3~+,CD4~+,CD8~+T lymphocyte and CD4/CD8 ratio of HC group were 1396�369/?L,692�223/?L,561�175/?L and 1.32�0.53.The numbers of CD3~+,CD4~+,CD8~+T cells and CD4/CD8 in the S-TB group were 860�395/?L,462�229/?L,342�198/?L,1.54�0.73 respectively.Compared with HC,the numbers of CD3~+,CD4~+,CD8~+T cells in tuberculosis group were significantly lower than those in control group(p<0.05);the ratio of CD4/CD8 in tuberculosis group were significantly higher than control group(p<0.05).(3)The number of T cell subsets in diabetic patients with or without tuberculosis:(1)There was no significant difference in the distributions of CD3~+,CD4~+,CD8~+T counts and CD4/CD8 ratios between DM group and HC group(p>0.05).(2)Compared with HC group,the numbers of CD3~+,CD4~+,CD8~+T cells in TB-DM group were significantly lower than those in HC group(p<0.05);the ratio of CD4/CD8 in TB-DM group were significantly higher than HC group(p<0.05).(3)There was no significant difference in the distributions of CD3~+,CD4~+,CD8~+T counts and CD4/CD8ratios between TB-DM group and S-TB group(p>0.05).(4)The number of T cell subsets in pneumonia patients with or without tuberculosis:(1)There was no significant difference in the distributions of CD3~+,CD4~+,CD8~+T counts and CD4/CD8 ratios between BP group and HC group(p>0.05).(2)Compared with HC group,the numbers of CD3~+,CD4~+,CD8~+T cells in TB-BP group were significantly lower than those in HC group(p<0.05);the ratio of CD4/CD8 in TB-BP group were significantly higher than HC group(p<0.05).(3)There was no significant difference in the distributions of CD3~+,CD4~+,CD8~+T counts and CD4/CD8 ratios between TB-BP group and S-TB group(p>0.05).(5)The number of T cell subsets in tuberculosis whether the merger of type 2 diabetes mellitus or bacterial pneumonia:There was no significant difference in the distributions of CD3~+,CD4~+,CD8~+T counts and CD4/CD8ratios between S-TB group,TB-DM group,TB-BP group and TB-BP-DM group(p>0.05).(6)The number of T cell subsets in Different severity of tuberculosis patients:according to the severity the TB group were divided into four groups:mild(A),moderate(B),severe(C)and extremely severe(D).Comparing the number of T lymphocytes between the four groups,the results showed that the counts of CD3~+,CD4~+,CD8~+T lymphocytes decreased gradually with the progression of the disease.The results of statistical analysis showed that:(1)CD3~+T cell counts:Compared with D group,the numbers of CD3~+T cell counts in A and B group were significantly higher than D group(p<0.05);Compared with C group,the numbers of CD3~+T cell counts in A group was significantly higher than C group(p<0.05).There was no significant difference in the number of CD3~+T cell count between A and B,B and C,C and D group(p>0.05).(2)CD4~+T cells counts:Compared with D group,the numbers of CD4~+T cells counts in A and B group were significantly higher than D group(p<0.05).There was no significant difference in the number of CD4~+T cells between A,B and C as well as C and D(p>0.05).(3)CD8~+T cells counts:Compared with D group,the numbers of CD8~+T cells counts in A group were significantly higher than D group(p<0.05).There was no significant difference in the number of CD8~+T cells between A,B and C as well as B,C and D(p>0.05).(4)There was no significant difference between the four CD4/CD8ratios in any pairwise comparison(p>0.05).Conclusion:(1)There was no significant differencein the distributions of CD3~+,CD4~+,CD8~+T counts and CD4/CD8 ratios between the different sexes and age groups in the HC,TB,BP and DM group.(2)Compared with the healthy group,the number of CD3~+and CD4~+T cells in peripheral blood decreased in tuberculosis patients,which was consistent with the results of previous studies.The difference with most previous studies was that the number of CD8~+T cells in TB patients was also found significantly decreased in this study.In addition,the number of cells decreased with the severity of the more obvious.Tip that T lymphocytes decreased may be related to the pathogenesis of tuberculosis,and have reference value to judgment the severity of tuberculosis patients.Tuberculosis patients may benefit from enhancing cellular immunotherapy.(3)The number of CD3~+,CD4~+,CD8~+T cells in the peripheral blood of diabetic patients was not decreased as compared with the healthy group,suggesting that the susceptible TB in diabetic patients was not related to the decrease of the above-mentioned cells.(4)The number of CD3~+,CD4~+,CD8~+T cells in patients with bacterial pneumonia did not decrease,suggesting that the decline in the number of cells may have some reference significance in differential diagnosis between tuberculosis and bacterial pneumonia.