病毒性心肌炎患者外周血中Th17细胞和调节性T细胞的变化研究

Changes of Th17 cells and regulatory T cells in peripheral blood of patients with viral myocarditis

目的探讨病毒性心肌炎患者外周血中Th17细胞和调节性T细胞(Treg细胞)的变化情况。方法选择医院2014年1月-2016年12月病毒性心肌炎患者80例,将其分为急性期组43例、恢复期组18例和迁延及慢性期组19例,选择健康体检者80例为对照组。采用流式细胞术测定外周血Th17细胞和Treg细胞水平,酶联免疫吸附测定(ELISA)法测定血清白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、白细胞介素-17(IL-17)、白细胞介素-21(IL-21)、转化生长因子-β(TGF-β)水平。结果病毒性心肌炎急性期和迁延及慢性期Th17/CD_4^+T、Treg/CD_4^+T、Th17/Treg均高于病毒性心肌炎恢复期和对照组(P<0.05);病毒性心肌炎迁延及慢性期Th17/CD_4^+T、Treg/CD_4^+T、Th17/Treg均高于病毒性心肌炎急性期(P<0.05);病毒性心肌炎恢复期和对照组Th17/CD_4^+T、Treg/CD_4^+T、Th17/Treg比较差异无统计学意义;病毒性心肌炎急性期和迁延及慢性期IL-1β、IL-6、IL-17、IL-21均高于病毒性心肌炎恢复期和对照组(P<0.05);病毒性心肌炎迁延及慢性期IL-1β、IL-6、IL-17、IL-21均高于病毒性心肌炎急性期(P<0.05);病毒性心肌炎恢复期和对照组IL-1β、IL-6、IL-17、IL-21比较差异无统计学意义;病毒性心肌炎急性期和迁延及慢性期TGF-β高于病毒性心肌炎恢复期和对照组(P<0.05);病毒性心肌炎迁延及慢性期TGF-β均高于病毒性心肌炎急性期(P<0.05);病毒性心肌炎恢复期和对照组TGF-β比较差异无统计学意义;病毒性心肌炎患者Th17细胞和Treg细胞呈负相关(P<0.05)。结论病毒性心肌炎急性期、迁延及慢性期患者存在外周血Th17细胞和Treg细胞失衡,以迁延和慢性期最为显著。

OBJECTIVE To explore the changes of Th17 cells and regulatory T cells（Treg cells）in peripheral blood of patients with viral myocarditis.METHODS A total of 80 patients with viral myocarditis who were treated in the hospital from Jan 2014 to Dec 2016 were enrolled in the study and divided into the acute phase group with 43 ca-ses,the convalescence group with 18 cases and the delayed and chronic phase group with 19 cases,80 healthy peo-ple who received physical examination were chosen as the control group.The levels of Th17 cells and Treg cells in peripheral blood were measured by using flow cytometry,the levels of serum interleukin-1β（IL-1β）,interleukin-6 （IL-6）,interleukin-17（IL-17）,interleukin-21（IL-1）and transforming growth factor-beta（TGF-β）were deter-mined by means of enzyme-linked immunosorbent assay（ELISA）.RESULTS The levels of Th17/CD4＋ T,Treg/CD4＋ T and Th17/Treg of the patients with viral myocarditis were significantly higher in the acute phase group and the delayed and chronic phase group than in the convalescence group and the control group（P〈0.05）;the levels of Th17/CD4＋ T,Treg/CD4＋ T and Th17/Treg of the patients with viral myocarditis were significantly higher in the delayed and chronic phase group than in the acute phase group（P〈0.05）;there was no significant difference in the level of Th17/CD4＋ T,Treg/CD4＋ T,or Th17/Treg between the convalescence group and the control group.The levels of IL-1β,IL-6,IL-17 and IL-21 of the patients with viral myocarditis were significantly higher in the acute phase group and the delayed and chronic phase group than in the convalescence group and the control group（P〈0.05）;the levels of IL-1β,IL-6,IL-17 and IL-21 of the patients with viral myocarditis were significantly higher in the delayed and chronic phase group than in the acute phase group（P〈0.05）;there was no significant difference in the level of IL-1β,IL-6,IL-17 or IL-21 between the convalescence group and the control group.The TGF-β level of the acute phase group and the delayed and chronic phase group was significantly higher than that of the convalescence group and the control group（P〈0.05）;the TGF-β level of the delayed and chronic phase group was significantly higher than that of the acute phase group（P〈 0.05）;there was no significant difference in the TGF-β level between the convalescence group and the control group.The Th17 cells of the pa-tients with viral myocarditis were significantly negatively correlated with Treg cells（P〈 0.05）.CONCLUSION The peripheral blood Th17 cells and Treg cells of the patients with viral myocarditis in the acute phase and the de-layed and chronic phase are imbalanced,with the delayed and chronic phase most significantly.