摘要
目的探讨糖尿病对老年患者肺结核免疫功能变化及病情的影响,为临床治疗提供依据。方法采用病例对照研究,纳入老年肺结核并糖尿病患者42例为A组,单纯肺结核患者30例为B组,健康体检者30例为C组。研究A、B两组临床特征,并以流式细胞术检测各组T细胞亚群(CD4+、CD8+和CD4+/CD8+),免疫比浊法检测各组免疫球蛋白(IgA、IgM和IgG)水平变化。结果 A组比B组发热、咳血增多,初治患者比例降低,痰涂阳性比例升高,结核空洞及病灶累及2个以上肺野的患者增多。A、B、C组CD8+依次降低,而CD4+及CD4+/CD8+依次升高。A组IgA、IgM和IgG均低于B组和C组,而B组IgA低于C组。A组中血糖未达标者CD4+、CD4+/CD8+、IgA、IgM和IgG均低于达标者,而CD8+高于达标者。结论老年肺结核患者合并糖尿病时病情加重,特别是血糖控制不良时尤为明显,可能与糖尿病导致免疫功能低下有关。
ObjectiveTo explore the impact of diabetes mellitus on immune functions in elderly pulmonary tuberculosis patients, for further understanding of the conditions to provide guidance for clinical practice. MethodsA case control study was adopted. Forty two cases of elderly patients with simple pulmonary tuberculosis and diabetes were enrolled as group A,30 patients with pulmonary tuberculosis as group B, and 30 healthy cases as group C. Clinical features of group A and B were observed, T cell subsets （CD4＋, CD8＋ and CD4＋/CD8＋） and immunoglobulin （IgA,IgM and IgG） levels in peripheral blood were detected with flow cytometry and immunoturbidimetry respectively. ResultsCompared with group B, in group A the incidence of fever and hemoptysis were increased, the proportion of initial treatment reduced, the ratio of smear positive increased, the tuberculous cavity and lesions involving more than 2 lungs increased,and CD8＋ decreased,while the CD4＋ level and CD4＋/ CD8＋ ratio were elevated in group A, B and C by turns. The levels of IgA, IgM and IgG in group A were lower than those in group B and group C, while IgA in group B was lower than those in group C. Within group A,as compared with patients with normal blood glucose, a higher CD8＋ level, and lower levels of CD4＋, CD4＋/CD8＋, IgA, IgM and IgG were observed in patients with blood glucose under standard. ConclusionThe elderly patients with pulmonary tuberculosis combined with diabetes mellitus got worse, especially became aggravated when blood glucose was poorly controlled,that may be correlated with the immune dysfunction caused by diabeters mellitus.
出处
《转化医学杂志》
2013年第4期222-224,共3页
Translational Medicine Journal
关键词
肺结核
糖尿病
免疫功能
老年人
Pulmonary tuberculosis
Diabetes
Immune function
Elderly
