亚低温治疗对缺氧缺血性脑病新生儿白细胞介素-17和调节性T细胞水平的影响

Effect of mild hypothermia therapy on the levels of interleukin-17 and regulatory T cells in newborns with hypoxic ischemic encephalopathy

目的探讨全身亚低温治疗对出生6~12 h的缺氧缺血性脑病(HIE)新生儿外周血白细胞介素-17(IL^(-1)7)和调节性T细胞(Treg)的影响。方法选取2015年11月至2017年9月新乡医学院第一附属医院新生儿科收治的出生后6~12 h的HIE患儿39例为研究对象,依据治疗方法分为亚低温组和对照组。对照组患儿采用常规支持治疗,亚低温组患儿在常规支持治疗基础上给予全身亚低温治疗。所有患儿治疗前和治疗72 h后行外周血IL^(-1)7和Treg细胞测定;出生后14、28 d行新生儿神经行为测定(NBNA)量表评分。结果治疗前,亚低温组与对照组中、重度HIE患儿血Treg细胞、IL^(-1)7水平比较差异均无统计学意义(P>0.05)。对照组中、重度HIE患儿及亚低温组重度HIE患儿治疗72 h后血Treg细胞、IL^(-1)7水平与治疗前比较差异均无统计学意义(P>0.05);亚低温组与对照组重度HIE患儿治疗72 h后血Treg细胞、IL^(-1)7水平比较差异均无统计学意义(P>0.05);治疗72 h后,亚低温组中度HIE患儿血Treg细胞水平显著高于治疗前(P<0.05),IL^(-1)7水平显著低于治疗前(P<0.05);亚低温组中度HIE患儿血Treg细胞水平显著高于对照组(P<0.05),IL^(-1)7水平显著低于对照组(P<0.05)。出生后14、28 d,亚低温组中度HIE患儿NBNA评分显著高于对照组(P<0.05),但2组重度HIE患儿NBNA评分比较差异无统计学意义(P>0.05)。结论出生后6~12 h中度HIE患儿行全身亚低温治疗可能仍然有效,而重度HIE患儿效果不明显,亚低温治疗HIE患儿可能通过升高Treg细胞比例和抑制IL^(-1)7产生而发挥脑保护作用。

Objective To investigate the effect of mild hypothermia therapy on the levels of interleukin-17（IL-17） and regulatory T cells（Treg） in 6-12 hours newborns with hypoxic ischemic encephalopathy.Methods A total of 39 newborns with HIE in the First Affiliated Hospital of Xinxiang Medical University from November 2015 to September 2017 were selected as research subjects.The newborns were divided into mild hypothermia group and control group according to the treatment method.The neonates in the control group received routine supportive treatment,while the neonates in the mild hypothermia group received routine supportive treatment and systemic mild hypothermia therapy.The levels of peripheral blood IL-17 and Treg cell were detected before treatment and 72 hours after treatment.The neonates were performed with neonatal behavioral neurological assessment（NBNA） scale at 14 and 28 days after birth.Results There was no significant difference in peripheral blood Treg cell and IL-17 levels of moderate and severe HIE neonates between mild hypothermia group and control group before treatment（P〈0.05）.After 72 h treatment,there was no significant difference in peripheral blood Treg cell and IL-17 levels of the moderate and severe HIE neonates in control group and the severe HIE neonates in the mild hypothermia group before and 72 hours after treatment（P〈0.05）.There was no significant difference in peripheral blood Treg cell and IL-17 levels of severe HIE neonates between the mild hypothermia group and control group at 72 hours after treatment（P〈0.05）.The peripheral blood Treg cell level of moderate HIE neonates after 72 hours of treatment was significantly higher than that before treatment in the mild hypothermia group（P〈0.05）.The peripheral blood Treg cell level of moderate HIE neonates in the mild hypothermia group was significantly higher than that in the control group after 72 hours of treatment（P〈0.05）.The peripheral blood IL-17 level of moderate HIE neonates after 72 hours of treatment was significantly lower than that before treatment in the mild hypothermia group（P〈0.05）.The peripheral blood IL-17 level of moderate HIE neonates in the mild hypothermia group was significantly lower than that in the control group after 72 hours of treatment（P〈0.05）.The NBNA score of moderate HIE neonates in mild hypothermia group was significantly higher than that in the control group at 14 and 28 days after birth（P〈0.05）.There was no significant difference in the NBNA score of severe HIE neonates between the mild hypothermia group and control group at 14 and 28 days after birth（P〈0.05）.Conclusions Mild hypothermia therapy for 6-12 hours newborns with moderate HIE may still be effective,but the mild hypothermia therapy for severe HIE neonates is not effective.Mild hypothermia may play a neuroprotective role by increasing the ratio of Treg cell and inhibiting the production of IL-17.