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目的明确结核性脑膜炎(TBM)和肺结核(PTB)患者结核分枝杆菌抗原特异性干扰素-γ酶联免疫斑点(IFN-γELISPOT)的数量差异,分析IFN-γ水平变化在TBM和PTB中的作用。方法通过TBM,PTB患者和健康人的外周血进行IFN-γELISPOT检测,比较效应性T细胞的数量差异,并通过1年随访,比较TBM和PTB患者IFN-γELISPOT阳性组和阴性组预后的差异。结果 TBM组IFN-γELISPOT阳性率为37.1%(13/35),PTB组IFN-γELISPOT阳性率为76.0%(19/25)。TBM组IFN-γELISPOTA(ESAT-6)和B(CFP-10)明显低于PTB组(P<0.05);患者的1年随访分析表明TBM和PTB患者IFN-γELISPOT阳性组GOS预后分析好于阴性组。结论 TBM患者IFN-γ水平明显低于PTB患者,相对低的IFN-γ的表达是预后不良机制之一,外源性IFN-γ补充可能使TBM患者获益。
OBJECTIVE: To determine the number differences of Mycobacterium tuberculosis antigen-specific IFN-γ ELISPOT in patients with tuberculous meningitis (TBM) and pulmonary tuberculosis (PTB), and to analyze the changes of IFN-γ levels in TBM and PTB Role. Methods IFN-γ ELISPOT was detected in peripheral blood of TBM, PTB and healthy volunteers. The difference of the number of effector T cells was compared. The difference of prognosis between IFN-γELISPOT positive group and negative group of TBM and PTB patients was compared by one-year follow-up. Results The positive rate of IFN-γELISPOT in TBM was 37.1% (13/35), and the positive rate of IFN-γELISPOT in PTB was 76.0% (19/25). IFN-γELISPOTA (ESAT-6) and B (CFP-10) in TBM group were significantly lower than those in PTB group (P <0.05). One year follow-up analysis showed that the prognosis of GOS in IFN-γELISPOT positive group was better than negative in TBM and PTB patients group. Conclusions The level of IFN-γ in patients with TBM is significantly lower than that in patients with PTB. The relatively low expression of IFN-γ is one of the poor prognostic factors in TBM patients. Exogenous IFN-γ supplement may benefit TBM patients.