【目的】 探讨新疆地区部分活动性肺结核患者中医证型与杀伤性免疫球蛋白样受体（killer-cell immunoglobulin-like receptors，KIR）亚型分布之间的关系，了解该地区部分活动性肺结核患者的临床特点，提供一定的结核病临床辅助诊断依 据。【方法】（1）收集 2021年 1月至 2021年 10月就诊于新疆医科大学第八附属医院呼吸与危重症医学科的活动性肺结核患者 338 例，采用描述性研究分析患者的一般资料、临床表现、共病情况。（2）收集 2021 年 1月至 2021年 10月就诊于新疆医科 大学第八附属医院呼吸与危重症医学科的230例活动性肺结核患者（初治130例、复治100例）及同期就诊于新疆医科大学附 属中医医院、乌鲁木齐友爱医院体检中心的108例健康人的全血，采用全血DNA提取试剂盒完成患者及健康人基因组DNA 提取，对 4种 KIR亚型（KIR2DL3、KIR2DS1、KIR2DS3及 KIR3DS1）进行检测。并将活动性肺结核患者的 KIR亚型分布与健 康人群进行对比，探索其分布规律。对初治、复治患者进行中医辨证，探讨新疆地区活动性肺结核的中医证型分布特点；探 索活动性肺结核患者的KIR亚型分布特点与中医证型之间的关联。【结果】（1）338例活动性肺结核患者中，初治患者230例，复 治患者 108 例，平均年龄（51.68 ± 19.93）岁。初治患者临床表现前 6 位依次为咳嗽、咯痰、纳差、寐差、乏力、胸闷气短， 复治患者临床表现前6位依次为咳嗽、咯痰、纳差、胸闷气短、寐差、乏力，复治患者发生咳嗽、咯痰以及活动后气促的频 率较初治患者更高（P＜0.05 或 P＜0.01）；初治患者共病疾病的前 5 位依次为 2 型糖尿病、高血压病、冠心病、结核性脑膜 炎、慢性支气管炎，复治患者共病疾病的前5位依次为高血压病、2型糖尿病、冠心病、慢性支气管炎、胆囊结石伴慢性胆 囊炎，其中，初治患者合并结核性脑膜炎的占比较高（P＜0.05），复治患者合并慢性阻塞性肺病的占比较高（P＜0.05）。（2）中 医证型在初治/复治活动性肺结核患者中的分布规律为：气阴两虚证＞阴阳两虚证＞阴虚火旺证＞肺阴亏虚证；抑制性亚型 KIR2DL3及活化性亚型 KIR2DS1广泛存在于活动性肺结核患者及健康人群中；复治患者中，KIR2DS3分布比例较高，气阴 两虚证的活动性肺结核患者主要表达KIR2DL3、KIR2DS1两种亚型；KIR2DS3可能是活动性肺结核患者肺阴亏虚证的特异性 标志物[OR（95%CI）=2.754（1.019，7.448），P=0.046]。【结论】 新疆地区部分活动性肺结核患者的中医证型以气阴两虚证为主； 初治、复治患者临床表现存在差异，共病情况复杂；KIR2DS3 可能是活动性肺结核患者肺阴亏虚证的特异性标志物； KIR2DL3、KIR2DS1两种基因亚型的表达可能与活动性肺结核气阴两虚证密切相关。

Objective To investigate the relationship between traditional Chinese medicine （TCM） syndrome types and the distribution of killer-cell immunoglobulin-like receptor （KIR） subtypes in partial patients with active pulmonary tuberculosis （PTB） in the Xinjiang region， and to understand the clinical characteristics of these patients，in order to provide a basis for clinical auxiliary diagnosis of tuberculosis. Methods （1） A total of 338 patients with active PTB treated in the Department of Respiratory and Critical Care Medicine at the Eighth Affiliated Hospital of Xinjiang Medical University from January to October 2021 were enrolled，including 230 newly-treated cases and 108 retreated cases. Descriptive analysis was used to analyze general data，clinical manifestations，and comorbidities.（2） Whole blood samples were collected from 230 active PTB patients （130 newly-treated cases，100 retreated cases） from the same department and period，and 108 healthy individuals from the Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University and Urumqi Youai Hospital Health Examination Center. Genomic DNA was extracted using a whole blood DNA extraction kit. Four KIR subtypes （KIR2DL3， KIR2DS1，KIR2DS3，and KIR3DS1） were detected. The distribution of KIR subtypes in active PTB patients was compared with that in healthy controls to explore its pattern. TCM syndrome differentiation was performed for newlytreated and retreated patients to explore the distribution characteristics of TCM syndrome types in active PTB in Xinjiang and to investigate the association between KIR subtypes and TCM syndrome types. Results （1） Among the 338 active PTB patients，there were 230 newly-treated cases and 108 retreated cases，with a mean age of （51.68 ± 19.93） years. The top six clinical manifestations in newly-treated cases were cough，expectoration，poor appetite， poor sleep， weakness， and chest tightness with shortness of breath； in retreated cases， they were cough， expectoration， poor appetite， chest tightness with shortness of breath， poor sleep， and weakness. The frequencies of cough，expectoration，and shortness of breath after activity were higher in retreated cases than in newly-treated cases （P＜0.05 or P＜0.01）. The top five comorbidities in newly-treated cases were type 2 diabetes， hypertension，coronary heart disease，tuberculous meningitis，and chronic bronchitis；in retreated cases，they were hypertension， type 2 diabetes， coronary heart disease， chronic bronchitis， and gallstones with chronic cholecystitis. The proportion of newly-treated cases complicated with tuberculous meningitis was relatively high （P＜0.05），while the proportion of retreated cases complicated with chronic obstructive pulmonary disease was relatively high （P＜0.05）.（2） The distribution of TCM syndrome types in newly-treated/retreated active PTB patients was：qi and yin deficiency syndrome > yin and yang deficiency syndrome > yin deficiency resulting in vigorous fire syndrome > lung yin depletion syndrome. The inhibitory subtype KIR2DL3 and the activating subtype KIR2DS1 were widely present in both active PTB patients and healthy controls. Among retreated cases， the distribution proportion of KIR2DS3 was relatively high. Active PTB patients with qi and yin deficiency syndrome mainly expressed KIR2DL3 and KIR2DS1 subtypes. KIR2DS3 might be a specific marker for lung yin depletion syndrome in active PTB patients [OR （95%CI） = 2.754（1.019，7.448），P = 0.046]. Conclusion In partial patients with active PTB in the Xinjiang region，qi and yin deficiency syndrome is the predominant TCM syndrome type. Clinical manifestations differ between newly-treated and retreated cases，with complex comorbidities. KIR2DS3 may be a specific marker for lung yin depletion syndrome in active PTB patients. The expression of KIR2DL3 and KIR2DS1 subtypes may be closely related to qi and yin deficiency syndrome in active PTB.

R259.21

省部共建中亚高发病成因与防治重点实验室开放课题项目（编号：SKL-HIDCA-2019-ZY4）