急性失代偿性心力衰竭患者外周血效应T细胞活性动态变化研究

Dynamic variation of peripheral blood effector T cell activity in acute decompensated heart failure

目的探讨急性失代偿性心力衰竭（ADHF）患者外周血效应T细胞亚群比例变化及其可能意义。方法入选2015年1-10月在首都医科大学附属北京安贞医院心内科和北京市海淀医院心内科住院的ADHF患者30例为ADHF组，采用流式细胞术检测患者入院和出院时外周血辅助性T细胞1（Th1）、Th2、Th17比例，另选取同期于北京市海淀医院体检中心检查的健康体检者20例为对照组，采用流式细胞术检测其外周血Th1、Th2、Th17比例。比较2组Th1、Th2和Th17细胞比例，分析ADHF组Th1、Th2和Th17细胞水平与临床指标的相关性，比较人院前是否用药对ADHF患者效应T细胞水平的影响。结果ADHF组入院时Th1、Th17细胞比例明显高于对照组[（26．44±6．76）％比（16．23±5．34）％、（2．36±1．03）％比（0．59±0．19）％]，出院时Th1、Th17细胞比例[（20．29±3．82）％、（1．27±0．58）％]明显低于人院时，但仍明显高于对照组，差异均有统计学意义（均P〈0．01）；ADHF组入院时Th2细胞比例明显低于对照组[（1．61±0．57）％比（3．06±0．69）％]，出院时Th2细胞比例[（2．37±0．68）％]明显高于人院时，但仍明显低于对照组，差异均有统计学意义（均P〈0．01）。ADHF组入院时三酰甘油与Th1水平呈负相关（r=-0．428，P〈0．05）；LVEDD与Th2水平呈负相关（r=-0．428，P〈0．05），与Th17水平呈正相关（r=0．386，P〈0．05）；LVEF与Th1水平呈负相关（r=-0．825，P〈0．01），与Th2水平呈正相关（r=0．417，P〈0．05）；脑钠肽与Th1、Th17水平呈正相关（r=0．705，0．393，均P〈0．01），与Th2水平呈负相关（r=-0．509，P〈0．05）；CRP和Th1水平呈正相关（r=0．448，P〈0．05）。入院前服用他汀类药物ADHF患者的Th1细胞水平明显低于未服用他汀类药物者[（25．95．4-8．67）％比（27．00±3．87）％]，差异有统计学意义（P〈0．05）。结论ADHF患者外周血Th1和Th17活性亢进，Th2细胞明显受抑。ADHF患者外周血效应T细胞变化可能与ADHF发生发展密切相关。

Objective To explore the variation of peripheral blood effector T cell subgroup ratio and its possible significance in patients with acute decompensated heart failure （ADHF）. Methods Thirty hospitalized patients with ADHF from January to October 2015 were enrolled as ADHF group, 20 healthy people were selected as control group. The flow cytometry was used tested ratios of peripheral blood helper T cell 1 （ Th1 ） , Th2 and Thl7. Ratios of Th1, Th2, Th17 and their correlation with other clinical indexes were analyzed. The effect of medication use before being hospitalized on of effector T cells in patients with ADHF were analyzed. Results At admission, ratios of Thl, Thl7 in ADHF group were significantly higher than those in control group[ （26.44 ± 6. 76）% vs（16.23±5.34）%,（2.36±1.03）% vs（0.59±0.19）%]（P〈0.01）; in ADHF group, ratios of Thl, Thl7 at discharge[ （20. 29 ± 3.82） %, （ 1.27 ± 0. 58） % ] were significantly lower than those at admission, but was still significantly higher than those in control group at discharge（P 〈0. 01 ）. At admission, ratios of TH2 in ADHF group was significantly lower than those in control group [ （ 1.61 ± 0. 57 ） % vs （ 3.06 ± 0. 69 ） % （ P 〈0. O1 ） ; in ADHF group, ratios of TH2 at discharge [ （ 2. 37 ± 0. 68 ） % was significantly higher than those at ad- mission, but was still significantly lower than those in control group at discharge（ P 〈 0. 01 ）. In ADHF group at admission, triacylglycerol and Thl were negatively correlated（ r = - 0. 428, P 〈 0. 05 ） ; left ventricular end-dias- tolic dimension（LVEDD） and Th2 were negatively correlated（ r = -0. 428, P 〈 0. 05 ）, LVEDD and Thl7 were positively correlated（ r =0. 586, P 〈 0. 05 ） ; left ventricular ejection fraction（LVEF） and Thl were negatively cor- related （ r = - 0. 825, P 〈 0. 01 ）, LVEF and Th2 were positively correlated （ r = 0.417, P 〈 0. 05 ） ; brain natri- uretic peptide（BNP） and Thl, Thl7 were positively correlated（r = 0. 705,0. 393, both P 〈 0. 01 ）, BNP and Th2 were negative correlated （ r = - 0. 509, P 〈 0. 05 ） ; C-reactive protein and Thl were positively correlated （ r = 0. 448, P 〈 0. 05 ）. The ratio of Thl in ADHF patients who had taken statins before being hospitalized was significantly lower than that in patients who had not [ （ 25.95 ± 8.67 ） % vs （ 27.00 ± 3.87 ） % ] （ P 〈 0. 05 ）. Conclusions Peripheral blood Th1 and Th17 ceils in ADHF patients are active, and Th2 cells are significantly inhibited. Peripheral blood effector T cells are closely correlated with the occurrence and development of ADHF.