动脉粥样硬化性脑梗死外周血辅助性T细胞17表达水平研究

The Role of Th17 in Stroke in Patients with Acute Atherosclerotic Cerebral Infarction

目的检测动脉粥样硬化性脑梗死患者外周血辅助性T细胞17(Thelper 17 cells,Th17)占CD4^+T细胞的比例及其与颈动脉内-中膜厚度(intima-media thickness,IMT)的关系。方法纳入首次发病的大动脉粥样硬化性脑梗死患者为研究组,同期健康体检者为对照组。比较研究组和对照组外周血Th17比例的差异。根据入院时美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分将研究组分为轻型组、中型组、重型组,比较这3组及对照组间外周血Th17比例的差异。另外,分析Th17比例与动脉粥样硬化性脑梗死患者年龄、性别、高血压病、糖尿病及高脂血症的关系,并计算Th17比例与颈动脉IMT值相关性。结果研究共纳入研究组45例,对照组32例。研究组较对照组外周血Th17比例显著增加([7.41±1.93)%vs(2.8±0.64)%,P<0.001)];研究组中轻型组7例、中型组19例、重型组19例,轻、中、重型组患者Th17比例分别为(4.97±0.89)%、(7.06±1.33)%及(8.65±1.71)%,均显著高于对照组(P均<0.001),且中型组高于轻型组(P=0.003)、重型组高于中型组(P=0.002)和轻型组(P=0.002)。研究组颈动脉IMT值与Th17比例呈显著正相关(r=0.68,P<0.001)。结论外周血Th17比例的升高可能参与了动脉粥样硬化性脑梗死的发生、发展过程。

Objective To explore the role of T helper cell 17 （Th17） in stroke evolving by detecting the level of Th17 in peripheral blood and its relationship with carotid artery intima-media thickness （IMT） in patients with acute atherothrombotic ischemic stroke. Methods Patients with first-ever acute atherosclerosis cerebral infarction were included in the stroke group, and the baseline characteristics matched healthy people as control. The levels of Th17 in peripheral blood between the two groups were compared. According to the National Institute of Health Stroke Scale （NIHSS） score at admission, the patients in stroke group were divided into light stroke, medium stroke and severe stroke subgroups. The level of Th17 between the two groups and among the three subgroups were compared. The relationship between the level of Th17 and risk factors of the patients such as age, gender, hypertension, diabetes, hyperlipidemia were analyzed. The correlation between Th17 and carotid artery intima-media thickness （IMT） was also analyzed. Results All the subjects from the stroke group （n=45） and control group （n=32） were investigated. The level of Th17 in stroke group was significantly higher than that in control group （[7.41±1.93]%vs [2.8±0.64]%, P〈0.001）. The percentage of Th17 in peripheral blood mononuclear cells in light stroke （4.97±0.89）%, medium stroke （7.06±1.33）% and severe stroke subgroup （8.65±1.71）% were all significantly higher than that in control group （all P value〈0.001）. The level of Th17 in medium stroke subgroup was higher than that in light stroke subgroup （P=0.003）. The level of Th17 in severe stroke subgroup were higher than that in medium （P=0.002） and light stroke subgroup （P=0.002）. There was a significantly positive correlation between the level of Th17 and IMT （r=0.68, P〈0.001）. Conclusion Elevated level of Th17 may enhance vascular inflammation and accelerate atherosclerotic cerebral infarction, and Th17 may involve in the pathogenesis of stroke.