结核病中的免疫耗竭现象
华雨琴 王雨菡

浙江中医药大学，浙江杭州，310053；

摘要：本文探讨了结核病中的免疫耗竭现象。结核病是由结核分枝杆菌引起的慢性呼吸道疾病，是全球重要的公共卫生问题。免疫耗竭表现为T细胞等功能逐渐丧失，包括细胞因子产生减少、抑制性受体（如PD-1、TIM-3、LAG-3）表达上调及增殖能力下降。在结核病中，持续的抗原刺激导致特异性T细胞出现耗竭表型，且与病原体负荷正相关。PD-1等通路的阻断可在一定程度上逆转耗竭，但完全抑制相关通路可能加剧免疫病理损伤，提示耗竭也可能是宿主防止过度免疫的适应性机制。此外，NK细胞、B细胞和巨噬细胞等也可能发生耗竭。中医将结核病归于“痨病”，强调体质因素，并采用中药、针灸等方法进行整体调节，具有一定的免疫调节作用。本文综合分析了结核病免疫耗竭的细胞表现、分子机制及中西医认识，为理解结核病免疫逃逸及治疗策略提供了参考。

关键词：结核分枝杆菌；免疫耗竭；痨病

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