T lymphocyte phenotypic profile in lung segments affected by cavitary and non-cavitary tuberculosis
T lymphocyte phenotypic profile in lung segments affected by cavitary and non-cavitary tuberculosis
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DOI：
10.1046/j.1365-2249.2003.02121.x
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发表时间：
2003-05-01
影响因子：
4.6
通讯作者：
Sanduzzi, A
中科院分区：
文献类型：
--
作者：
Mazzarella, G;Bianco, A;Sanduzzi, A
肺结核（TB）的临床表现可能取决于宿主和病原体之间复杂的相互作用。肺结核的临床结局是可变的，从无症状的终身感染到肺实质破坏，导致空洞性病变。为了研究局部细胞免疫反应可能影响结核病的表现和预后的假设，我们对空洞性和非空洞性结核病的肺段进行了支气管肺泡灌洗（BAL）。然后，我们将受累肺段水平的细胞反应类型与空洞形成方面的临床演变相关联。我们发现空洞型和非空洞型肺结核患者的肺泡淋巴细胞增多，非空洞型肺结核患者的CD 4（+）淋巴细胞增加。在非空洞患者中观察到了占主导地位的Th 1免疫应答，而空洞受累节段表现出Th 2淋巴细胞亚群的存在。这些数据证实了Th 1型CD 4（+）细胞和IFN-γ在活动性肺结核有效细胞免疫中的重要性，同时也表明Th 2淋巴细胞的存在可能有助于与肺结核空洞演变相关的组织坏死现象。我们的观察结果表明，在不同的临床特征和结果的肺结核病的发展在疾病部位的局部免疫反应的类型的重要性。
Clinical manifestations of pulmonary tuberculosis (TB) may depend on a complex interaction between the host and the pathogen. Clinical outcomes of pulmonary tuberculosis are variable, ranging from asymptomatic lifelong infection to parenchymal lung destruction, resulting in cavitary lesions. To investigate the hypothesis that local cellular immune response may affect presentation and outcome in tuberculosis, we performed bronchoalveolar lavage (BAL) in lung segments affected by cavitary and non-cavitary tuberculosis. We then correlated the type of cellular response at the level of the involved lung segments with clinical evolution in terms of cavity formation. We found alveolar lymphocytosis in patients with both cavitary and non-cavitary pulmonary tuberculosis, with increased CD4(+) lymphocytes in patients with non-cavitary pulmonary tuberculosis. A predominant Th1 immune response has been observed in non-cavitary patients, while cavitary involved segments exhibit the presence of Th2 lymphocyte subsets. These data, while confirming the importance of Th1-type CD4(+) cells and IFN-gamma in effective cellular immunity in active pulmonary tuberculosis, also suggest that the presence of Th2 lymphocytes may contribute to tissue necrosis phenomena associated with cavitary evolution of pulmonary tuberculosis. Our observations indicate the importance of the type of local immune response at the site of disease in the development of different clinical characteristics and outcome in pulmonary tuberculosis.