支氣管肺泡灌洗液腺苷脫氨酶及T細胞亞群在肺結核診斷中的應用價值

朱鳳嬌　潘連連　王傳捷　葉軍輝

[摘要] 目的 探討支氣管肺泡灌洗液腺苷脫氨酶（ADA）及T細胞亞群在肺結核診斷中的應用價值。 方法 選取2015年1月～2017年1月我院30例肺結核患者為觀察組，另選取同期就診的肺部良性病變患者30例為對照組。兩組患者均行支氣管肺泡灌洗，收集支氣管肺泡灌洗液檢測ADA及T淋巴細胞亞群。觀察并比較兩組患者的肺泡灌洗液ADA及T淋巴細胞亞群的差異。 結果 觀察組患者支氣管肺泡灌洗液ADA含量明顯高于對照組，差異有統計學意義（P<0.05）；觀察組患者支氣管肺泡灌洗液T淋巴細胞CD3+、CD4+、CD4+/CD8+水平明顯低于對照組，CD8+水平明顯高于對照組，差異均有統計學意義（P<0.05或P<0.01）。 結論 肺結核患者免疫功能低下，檢測支氣管肺泡灌洗液ADA及T淋巴細胞亞群能為臨床診斷肺癌提供依據，具有較高的臨床應用價值。

[關鍵詞] 肺結核；支氣管肺泡灌洗液；腺苷脫氨酶；T淋巴細胞亞群

[中圖分類號] R521 [文獻標識碼] B [文章編號] 1673-9701（2017）36-0124-04

[Abstract] Objective To investigate the application value of bronchoalveolar lavage fluid adenosine deaminase and T cell subsets in the diagnosis of pulmonary tuberculosis. Methods 30 patients with pulmonary tuberculosis from January 2015 to January 2017 were selected as the observation group. 30 patients with benign lung lesions in the same period were selected as the control group. Two groups of patients underwent bronchoalveolar lavage. The ADA and T lymphocyte subsets in the bronchoalveolar lavage fluid were collected. The differences of ADA and T lymphocyte subsets in the alveolar lavage fluid were observed and compared between the two groups. Results The ADA content of bronchoalveolar lavage fluid in the observation group was significantly higher than that in the control group， and the difference was significant（P<0.05）. The levels of CD3+， CD4+， CD4+/CD8+ in T lymphocytes of bronchoalveolar lavage fluid in the observation group were significantly lower than those in the control group， and CD8+ level in the observation group was significantly higher than that in the control group， and the difference was statistically significant（P<0.05 or P<0.01）. Conclusion Tuberculosis patients have low immune function. The detection of ADA and T lymphocyte subsets in bronchoalveolar lavage fluid can provide the basis for clinical diagnosis of lung cancer， and have high clinical application value.

[Key words] Tuberculosis； Bronchoalveolar lavage fluid； Adenosine deaminase； T lymphocyte subsets

肺結核是臨床常見的呼吸道傳染病，有研究顯示全球有近1/3的患者感染過結核分枝桿菌，我國是結核病高發區域，患病率高、死亡率高[1-3]。早期診斷與治療是改善肺結核患者預后的關鍵，找到結核桿菌是診斷肺結核的金標準，但臨床上痰菌陰性的肺結核患者占總患者的65%～75%[4，5]。支氣管肺泡灌洗術（bronchoalveolar lavage，BAL）是運用支氣管鏡對支氣管以下肺段或亞肺段水平，反復以無菌生理鹽水灌洗、回收，獲得支氣管肺泡灌洗液（bronchoalveolar lavage fluid，BALF），從病原微生物學、分子生物學、免疫學、細胞學及酶學等角度檢測分析BALF性質，近年來逐漸應用于早期診斷肺結核的診斷及治療中[6-8]。本研究通過檢測腺苷脫氨酶（adenosine deaminase，ADA）及T細胞亞群，探討其對肺結核的診斷價值，現報道如下。

1 資料與方法

1.1 一般資料

選取2015年1月～2017年1月期間在我院就診的肺結核患者共30例為觀察組。納入標準：根據痰液檢查抗酸桿菌、病理學特征、影像學檢查等確診為肺結核?！?br>