结核性胸膜炎的发病机制目前仍不清楚。研究表明，免疫缺陷是结核性胸膜炎的重要发病因素。本研究主要通过检测结核性胸膜炎患者外用血和胸腔积液中CD4⁺ 和CD8⁺T 细胞的比例变化及其活化程度，分析并探讨结核性胸膜炎患者机体免疫状况。在筛选病例后收集患者的外用血和胸腔积液，分离出单核细胞，采用流式细胞仪检测CD4⁺ 和CD8⁺T细胞的比例以及人自细胞抗原DR(HLA-DR) 表面活化标记和颗粒酶B 在CD8⁺T 细胞中的表达水平。结果显示结核性胸膜炎患者外用血中CD3⁺ 、CD4⁺ 和CD8⁺T 细胞的比例均低于健康对照组。患者胸腔积液中CD3⁺和CD4⁺T 细胞的比例均显著高于外用血，而CD8⁺T 细胞无显著差异。患者外用血中CD4⁺ HLA⁺ 和CD8⁺HLA⁺T 细胞显著高于健康对照组，而CD8⁺颗粒酶B⁺ T细胞显著低于健康对照组。患者胸腔积液中CD4⁺ HLA⁺ 、CD8⁺HLA⁺ 和CD8⁺颗粒酶B⁺T 细胞均显著低于外周血，仅外周血中CD8⁺T 细胞比例与颗粒酶B 水平呈正相关。以上结果表明，结核性胸膜炎患者外用血与胸腔积液中的免疫应答存在差异，提示患者可能存在免疫缺陷。

The pathogenesis of tuberculous pleurisy remains unclear. Evidences have shown that immuno-imbalance is an important risk factor for this condition. The present paper aimed to profile CD4 ⁺ and CD8 ⁺ T cells in patients with tuberculous pleurisy. A total of 30 cases were selected and their peripheral blood and pleural fluid were collected. The mononuclear cells were isolated. The CD4 ⁺ cells, CD8 ⁺ T cells, activation surface markers of human leukocyte antigen (HLA)-DR, and granzyme B level in CD8⁺ T cells were detected by flow cytometry. The results showed that the proportions of CD3 ⁺ , CD4 ⁺ and CD8 ⁺ T cells in peripheral blood samples collected from the patients with tuberculous pleurisy were lower than those in the control group. The proportions of CD3 ⁺ and CD4 ⁺ T cells in patients' pleural effusion were higher than those in peripheral blood, but the proportion of CD8 ⁺ T cells had no significant difference. The levels of HLA-DR on CD4 ⁺ and CD8 ⁺ T cells in peripheral blood in patients with tuberculous pleurisy were higher than those in the control group. And the level of CD8⁺ granzyme B⁺ T cells in patients with tuberculous pleurisy was lower than that in the control group. In patients , the levels of CD4 ⁺ HLA ⁺ , CD8 ⁺ HLA ⁺ and CD8⁺ granzyme B⁺ T cells in pleural effusion were lower than those in peripheral blood. In patients' peripheral blood there was a positive correlation between CD8 ⁺ T cells and granzyme B level. The results suggested that the immune response between peripheral blood and pleural fluid in patients with tuberculous pleurisy were different. Immuno-imbalance may play a critical role in the development/prognosis of the disease.