急性脑梗死患者单核细胞CD14^+CD16^+亚型的表达变化及临床意义

Changes of monocyte CD14^+CD16^+ subtypes in patients with acute cerebral infarction and its clinical significance

目的探讨急性脑梗死患者单核细胞CD14^+CD16^+亚型的表达及其临床意义。方法选择发病<24h入院的36例急性脑梗死患者为脑梗死组、同期在神经内科治疗的32例头晕患者为对照组,检测脑梗死组患者入院当天及第2、5、7~10天以及随访第90天,对照组入院当天的血清单核细胞计数、单核细胞各亚型百分比,分析单核细胞亚型与病情的关系。结果与对照组相比,脑梗死组经典型单核细胞百分比各时间点均无明显变化(均P>0.05);中间型单核细胞百分比入院当天及第2、5、7~10天均明显升高(均P<0.05);非经典型单核细胞百分比入院第2、5天均明显下降(均P<0.05)。脑梗死组入院当天单核细胞计数与NIHSS评分呈正相关(r=0.508,P<0.05);3个亚型百分比与NIHSS评分均未见相关(均P>0.05)。与未感染者比较,脑梗死感染患者入院第2、5、7~10天单核细胞计数均明显升高(均P<0.05),非经典型单核细胞百分比均明显下降(均P<0.05);中间型单核细胞百分比入院当天及第2、5天均明显升高(均P<0.05);经典型单核细胞百分比各时间点比较差异均无统计学意义(均P>0.05)。与预后良好组比较,脑梗死预后不良组入院第2、5天单核细胞计数、中间型单核细胞百分比均明显升高(均P<0.05),非经典型单核细胞百分比均明显下降(均P<0.05);经典型单核细胞百分比各时间点比较差异均无统计学意义(均P<0.05)。结论急性脑梗死患者单核细胞CD14^+CD16^+亚型变化有一定的规律,中间型单核细胞、非经典型单核细胞可能与脑梗死相关感染及预后有关。

Objective To investigate the changesof CD14＋CD16＋ monocytes in patients with acute cerebral infarction and clinical significance. Methods Thirty six patients with acute cerebral infarction admitted within 24 h of onset （study group） and 32 patients with dizziness hospitalizedat the same period （control group） were enrolled in the study. The peripheral monocyte count and the percentage of monocyte subtype in study groupwere determined at 0, 2, 5, 7-10d after admission and 90d in the followed up; those were measure at admission in control group. The correlation between monocyte subtypes and the progression of acute cerebral infarction was analyzed. Results Compared with the control group, the percentage of typical monocytes （CD14＋＋CD16） showed no significant changes at all time points in cerebral infarction group （P 〉0.05）. The percentage of inter- mediate monocytes （CD14＋＋CD16＋）was significantly increased at d0, d2, d5, d7 and d10 after admission（P〈0.05）, the percent- age of non-typical monocytes（CD14＋CD16＋＋） was significantly decreased at d2 and d5 （P〈0.05）. There was a positive correlation between monocyte count and NIHSS score （r=0.508, P〈0.05） at admission, while no correlation between the subtypes of mono- cytes and NIHSS scores （P 〉0.05）. Compared with non-infected patients, the monocyte count in infected cerebral infarction pa- tients was significantly increased （P〈0.05）, the percentage of non-typical monocytes was significantly decreased （P〈0.05）, the intermediate monocytes were significantly increased（P〈0.05） at dO, d2 and d5 of admission, while the typical monocytes showed no significant differences at all time points （P〈0.05）. Compared with the petients with good prognosis, the monocyte count and the percentage of intermediate monocytes were significantly increased at d2 and d5 in patients with poor prognosis（P〈0.05）, and the percentage of non-typical monocytes was significantly decreased （P〈0.05）, but the percentage of typical monocytes showedno significant difference at all time points （P 〉0.05）. Conclusion The CD14＋CD16＋ monocytes change with the progression of the disease in patients with acute cerebral infarction. The changes of intermediate monocytes and non-typical monocytes may be related to the infection and prognosis of cerebral infarction.