LYMPHOCYTE AND LYMPHOCYTE SUBSET NUMBERS IN BLOOD AND IN BRONCHOALVEOLAR LAVAGE AND PLEURAL FLUID IN VARIOUS FORMS OF HUMAN PULMONARY TUBERCULOSIS AT PRESENTATION AND DURING RECOVERY

被引:57
作者
AINSLIE, GM [1 ]
SOLOMON, JA [1 ]
BATEMAN, ED [1 ]
机构
[1] UNIV CAPE TOWN, DEPT MED, RESP CLIN, CAPE TOWN 7925, SOUTH AFRICA
关键词
D O I
10.1136/thx.47.7.513
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Background Lymphocytes have a central role in human defences against mycobacteria. A study was designed to assess the relation between lymphocyte responses and clinical pattern of disease, nutrition and recovery during treatment in patients with tuberculosis. Methods Lymphocyte numbers and subsets (on the basis of CD3, CD4, and CD8 monoclonal antibodies) were measured in peripheral blood and, where appropriate, bronchoalveolar lavage or pleural fluid of patients with different forms of pulmonary tuberculosis. Eleven had localised pulmonary tuberculosis, 18 miliary tuberculosis and seven a tuberculous pleural effusion. Results CD4 lymphocytes were found in greatly increased numbers in pleural fluid and were relatively depleted in the blood. Lymphocyte numbers in bronchoalveolar lavage fluid varied widely in localised pulmonary and miliary tuberculosis but were highest in lavage fluid from patients with miliary tuberculosis. This was due to an increase in CD8 lymphocytes, which were also increased in the blood. Lymphocyte numbers bore no relation to nutrition, symptom duration, or radiographic profusion scores. In miliary tuberculosis the time taken for the chest radiograph to clear (mean (SD) 17.6 (7.8) weeks) correlated with lymphocyte numbers in lavage fluid, especially CD8 cells (r = 0.74), but not with the patients' age or nutrition. After 8 weeks' treatment, total and CD4 lymphocyte numbers in lavage fluid showed a substantial increase. Conclusion The association of CD8 cells with delayed recovery is compatible with suppression of the antimycobacterial action of macrophages. The switch to predominance of CD4 cells in lavage fluid during successful treatment supports the view that they may have a role in eliminating mycobacteria.
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页码:513 / 518
页数:6
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