隐球菌性脑膜炎患者外周血中Th9和Th17细胞水平变化及意义

目的：比较初发隐球菌性脑膜炎患者治疗前后与健康对照人群外周血 CD4＋ T 细胞中 Th9和 Th17细胞的比值，探讨 Th9和 Th17细胞在隐球菌性脑膜炎发病机制中的作用。方法选取初发未经治疗隐球菌性脑膜炎患者及健康对照各12例，抽取隐球菌性脑膜炎患者治疗前和治疗后3周及健康对照的外周血，分离外周血单核细胞，应用流式细胞仪检测技术对3组病例外周血 CD4＋ T 细胞中 Th9和 Th17的比值进行比较。结果与健康对照相比，隐球菌性脑膜炎患者治疗前Th17表达下调，差异有统计学意义；在治疗好转患者中，治疗后 Th17表达显著上调，与治疗前及健康对照相比差异均有统计学意义。Th9在治疗前与健康对照相比无差异，在治疗后隐球菌性脑膜炎患者中表达上调。结论 Th17免疫途径是隐球菌性脑膜炎患者抵御隐球菌感染的重要免疫机制，隐球菌性脑膜炎发病及治疗拮抗可能与 Th17缺乏有关。

Expression and significance of Th9 and Th17 in the peripheral blood of patients with cryptococcal meningitis

Objective To explore the role of Th9 and Th17 cells in the pathogenesis of CM by mesureing the ratio of Th9 and Th17 cells in CD4 ＋ T lymphocyte of patients with cryptococcal meningitis（CM）. Methods Twelve CM patients without antifungal treatment and 12 healthy controls were selected. The peripheral blood was collected from patients prior treatment and three weeks af-ter treatment and the healthy controls. The ratio of Th9 and Th17 cells in peripheral blood were analyzed by flow cytometry. Result The ratio of Th17 cells in patients with CM before treatment was less than those of healthy people,and patients who received treat-ment showed the increased level of Th17 cells which was higher than those in patients before treatment and the healthy controls. The ratioof Th9 also increased in the patients who received treatment while there was no significant different between the patients before treatment and the healthy controls. Conclusion Th17 immune pathway is an important immune mechanism against Cryptococcus in-fection in patients with CM. The lack of Th17 cells may play a role in the pathogenesis and treatment-resistant of CM.