分析不同肺肉芽肿组织中CXCR5分子的表达差异及对肺结核与肺结节病的鉴别诊断意义。

选择2016年1月至2022年12月我院收治的经支气管镜下肺组织活检确诊为肺肉芽肿性炎患者43例，其中肺结节病15例、肺结核病28例；应用免疫组织化学技术分析组织切片中CXCR5分子表达，采用双重免疫荧光标记法分析组织切片中CXCR5在CD8^＋ T细胞、CD4^＋ T细胞上的表达，进行定量评分。

肺结核肉芽肿组织中CXCR5阳性表达大于2分22例(78.57%)，表达强度大于2分12例(42.86%)，定量评分小于3分10例(35.71%)、定量评分大于6分8例(28.57%)；肺结节病肉芽肿组织中CXCR5阳性表达大于2分9例(60.00%)，CXCR5表达强度小于2分15例(100.00%)，定量评分小于3分11例(73.33%)。与肺结节病相比，肺结核肉芽肿组织中CXCR5分子表达强度升高，整体评分增加[(4.00±2.12) vs. (2.18±1.87)]分(P<0.05)。ROC分析表明，最佳cut-off值CXCR5表达定量评分为2.85分时，肺结核与肺结节病鉴别诊断AUC＝0.733，特异性73.3%，敏感性64.3%。荧光共定位分析显示，和肺结节病相比，肺结核肉芽肿组织中滤泡CD4^＋ T细胞(0.7933 vs. 0.5150)和滤泡CD8^＋ T细胞的(0.8350 vs. 0.6100)浸润水平增加(P<0.05)。

肺结核与肺结节肉芽肿组织中CXCR5及表面标记的滤泡CD4^＋ T细胞和CD8^＋ T细胞的表达存在差异，具有鉴别诊断意义。

To analyze CXCR5 molecule expression in different pulmonary granulomatous tissues and to explore its differential diagnostic value between pulmonary tuberculosis and pulmonary sarcoidosis.

43 patients with lung granulomatosis were diagnosed by bronchoscopic lung tissue biopsy from the First Affiliated Hospital of Soochow University from January 2016 to December 2022. Fifteen cases of pulmonary sarcoidosis and 28 cases of pulmonary tuberculosis were comprehensively diagnosed. The expression of CXCR5 molecules in tissue sections was analyzed by immunohistochemistry. The expression of CXCR5 in CD8⁺ T cells and CD4⁺ T cells of granuloma tissue sections was analyzed by dual immunofluorescence labeling, and quantitative scoring was performed.

In pulmonary tuberculosis granuloma tissues, there were 22 cases (78.57%) with positive expression of CXCR5 greater than 2 points, 12 cases (42.86%) with expression intensity greater than 2 points, 10 cases (35.71%) with quantitative scores less than 3 points, and 8 cases (28.57%) with quantitative scores greater than 6 points. In the granuloma tissues of pulmonary sarcoidosis, there were 9 cases (60.00%) with positive expression of CXCR5 greater than 2 points, and the intensity of CXCR5 expression was less than 2 points in 15 cases(100.00%), and 11 cases (73.33%) were less than 3 points. Compared with pulmonary sarcoidosis, the expression intensity of CXCR5 molecules in pulmonary tuberculous granulomatous tissues was increased. The overall score of CXCR5 molecular expression was also increased (4.00±2.12) vs.( 2.18±1.87) (P<0.05). According to the ROC analysis, CXCR5 expression quantitative score was the best cut-off value when it was equal to 2.85 points. The AUC of the differential diagnosis of pulmonary tuberculosis and pulmonary sarcoidosis was 0.733, with a specificity of 73.3% and a sensitivity of 64.3%. Fluorescence colocalization analysis showed that the infiltration levels of follicular CD4⁺ T cells (0.7933 vs. 0.5150) and follicular CD8⁺ T cells (0.8350 vs. 0.6100) in pulmonary tuberculosis granuloma tissues were also increased compared with pulmonary sarcoidosis(P<0.05).

There are differences in the expression of CXCR5 molecule and surface-labeled follicular CD4⁺ T cells and follicular CD8⁺ T cells in granulomatous tissues of pulmonary tuberculosis and pulmonary sarcoidosis, which has differential diagnostic value.