Scioscia Giulia, Lacedonia Donato, Giuffreda Ernesto, Caccavo Incoronata, Quarato Carla Maria Irene, Soccio Piera, Tondo Pasquale, Sassani Ennio Vincenzo, Pescatore Dalila, Foschino Barbaro Maria Pia
Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
Institute of Respiratory Diseases, Policlinico Riuniti of Foggia, Foggia, Italy.
Front Med (Lausanne). 2022 Sep 7;9:890609. doi: 10.3389/fmed.2022.890609. eCollection 2022.
It is still unclear if low lymphocyte levels are directly related to immunological modifications induced by the TB infection or if they depend on the general pre-existing health impairment of affected patients. Our aim was to detect eventual differences in the immunological status of patients with pulmonary TB compared to an age and sex-matched group of hospitalized patients with other bacterial community-acquired pneumonia (CAP). In addition, we tried to assess an association between alterations in the peripheral lymphocyte subsets and the development of different CT patterns of active TB and to discover differences in the immunological status and in the radiological patterns of TB presentation between patients of different geographic proveniences.
This observational study included 48 patients with TB and 48 sex- and age-matched patients affected by other bacterial CAP. The presence of HIV/AIDS, other immunocompromising conditions, and confounding chronic pulmonary comorbidities was excluded. Flow cytometry was performed on all the enrolled subjects at admission, before starting the appropriate antibiotic therapy. Patients with TB also underwent a computed tomography (CT) scan.
Patients with TB showed a decrease in the absolute count of all the lymphocyte subsets compared to the CAP group. Only the reduction in the percentage of CD4+ T-lymphocytes was significant, while the percentage of CD8+ T-lymphocytes was significantly increased. Patients presenting exudative forms with atypical locations of TB showed a significant reduction in the absolute count and percentage of CD19+ B-lymphocytes compared to those affected by productive TB forms with the typical location. Despite being younger, our black Sub-Saharan Africans showed a significant reduction in the CD4+ T-lymphocytes compartment and a higher prevalence of atypical and exudative forms of TB compared with white Europeans.
Tuberculosis itself may alter peripheral blood lymphocyte subsets compared to other CAP. An impaired CD19+ B-lymphocyte compartment may result in an abnormal exudative response in atypical locations and a suboptimal bacterial control. Other constitutive or environmental causes may influence immunological differences found in patients with TB, particularly in case of different geographic origins. Anyhow, flow cytometry may be of great value in evaluating the immune function of these patients.
目前尚不清楚淋巴细胞水平低是直接与结核病感染引起的免疫改变相关，还是取决于受影响患者先前存在的一般健康损害。我们的目的是检测与年龄和性别匹配的其他细菌性社区获得性肺炎（CAP）住院患者相比，肺结核患者免疫状态的最终差异。此外，我们试图评估外周淋巴细胞亚群的改变与活动性肺结核不同CT模式的发展之间的关联，并发现不同地理来源患者的免疫状态和肺结核表现的放射学模式的差异。
这项观察性研究纳入了48例肺结核患者和48例年龄和性别匹配的其他细菌性CAP患者。排除了HIV/AIDS、其他免疫功能低下情况和混杂的慢性肺部合并症。在开始适当的抗生素治疗之前，对所有入组受试者入院时进行流式细胞术检测。肺结核患者还接受了计算机断层扫描（CT）。
与CAP组相比，肺结核患者所有淋巴细胞亚群的绝对计数均下降。只有CD4 + T淋巴细胞百分比的下降具有统计学意义，而CD8 + T淋巴细胞百分比显著增加。与典型部位的增殖性肺结核形式患者相比，表现为渗出性形式且肺结核部位不典型的患者CD19 + B淋巴细胞的绝对计数和百分比显著降低。尽管年龄较小，但与欧洲白人相比，我们撒哈拉以南非洲黑人的CD4 + T淋巴细胞区室显著减少，非典型和渗出性肺结核形式的患病率更高。
与其他CAP相比，结核病本身可能会改变外周血淋巴细胞亚群。CD19 + B淋巴细胞区室受损可能导致非典型部位出现异常渗出反应和细菌控制不佳。其他内在或环境因素可能会影响肺结核患者的免疫差异，特别是在不同地理来源的情况下。无论如何，流式细胞术在评估这些患者的免疫功能方面可能具有重要价值。
