目的分析耐药肺结核患者外周血Th17细胞与CD4~+CD25~+Foxp3~+T细胞比例及细胞因子的变化,从免疫学角度探讨其耐药机制。方法分别选取33例耐药肺结核(耐药组)、49例普通肺结核(普通组)及51例健康志愿者(对照组)展开对比研究。检测Th17细胞与CD4~+CD25~+Foxp3~+T细胞比例;采用RT-PCR检测其特异性转录因子RORγt与Foxp3的mRNA表达水平;采用ELISA实验检测IL-17A、IL-17F、TGF-β1及IL-10的血清水平。结果普通组Th17细胞比例和RORγt mRNA表达水平低于对照组,耐药组低于普通组;普通组CD4~+CD25~+Foxp3~+T细胞比例和Foxp3 mRNA表达水平高于对照组,耐药组高于普通组;普通组Th17/CD4~+CD25~+Foxp3~+T和RORγt/Foxp3低于对照组,耐药组低于普通组(P<0.05)。普通组IL-17A、IL-17F水平低于对照组,耐药组低于普通组;普通组TGF-β1、IL-10水平高于对照组,耐药组高于普通组;其组间差异均有统计学意义(P<0.05)。结论 Th17/CD4~+CD25~+Foxp3~+T平衡向CD4~+CD25~+Foxp3~+T偏移、免疫系统功能抑制,可能是结核病慢性化和产生耐药的重要机制之一。 Objective To analyze the changes of Th17 cells and CD4 ~ + CD25 ~ + Foxp3 ~ + T cells in peripheral blood of patients with drug-resistant pulmonary tuberculosis and their cytokines, and to explore the mechanism of drug resistance from the perspective of immunology. Methods 33 cases of drug-resistant pulmonary tuberculosis (drug-resistant group), 49 cases of common tuberculosis (general group) and 51 healthy volunteers (control group) were selected to conduct a comparative study. The ratio of Th17 cells to CD4 ~ + CD25 ~ + Foxp3 ~ + T cells was detected by RT-PCR. The mRNA levels of RORγt and Foxp3 were detected by RT-PCR. The levels of IL-17A, IL-17F and TGF- And serum levels of IL-10. Results The percentage of Th17 cells and RORγt mRNA expression in normal group were lower than those in control group, and the level of CD4 ~ + CD25 ~ + Foxp3 ~ + T cells and Foxp3 mRNA in common group were lower than those in control group The levels of Th17 / CD4 ~ + CD25 ~ + Foxp3 ~ + T and RORγt / Foxp3 in the common group were lower than those in the control group, while those in the resistant group were lower than those in the normal group (P <0.05). The levels of IL-17A and IL-17F in the common group were lower than those in the control group, while those in the drug-resistant group were lower than those in the normal group. The levels of TGF-β1 and IL-10 in the common group were higher than those in the control group, All were statistically significant (P <0.05). Conclusion The balance of Th17 / CD4 ~ + CD25 ~ + Foxp3 ~ + T shifted to CD4 ~ + CD25 ~ + Foxp3 ~ + T and inhibited the immune system, which may be one of the important mechanisms of chronicity and drug resistance of