颅内动脉瘤破裂患者手术前后Th17/Treg的变化

Postoperative changes of Th17/Treg balance in patients with intracranial aneurysm rupture

目的评价Th17/Treg细胞平衡在颅内动脉瘤破裂患者手术前后的变化与意义。方法收集73例动脉瘤破裂患者,比较术前、术后24、72 h及1周的Th细胞及胞内细胞因子介素-17(IL-17)、Treg及细胞因子介素-10(IL-10)的百分含量;并以未破裂的62例动脉瘤患者及65例健康志愿者作为标本对照。分析动脉瘤破裂患者出院时NIHSS、ADL及住院天数与Th17/Treg细胞平衡、细胞因子的相关性。结果破裂与未破裂动脉瘤患者的Th17及IL-17均显著高于健康志愿者,且破裂组显著高于未破裂组;而Treg及TGF-β1显著低于健康志愿者,且破裂组显著低于未破裂组(均为P<0.05)。与术前比较,动脉瘤破裂患者术后24 h的Th17及IL-17含量均显著升高,而Treg及TGF-β1均显著较低(P<0.05);术后72 h,动脉瘤破裂患者Th17及IL-17含量较术后24h均回落,而Treg及TGF-β1上升(P<0.05);术后1周,动脉瘤破裂患者Th17及IL-17含量较术后72 h均明显回落,Treg和TGF-β1较术后72 h显著上升(P<0.05)。动脉瘤破裂患者Th17、IL-17与NIHSS、住院天数呈正相关性,而与ADL呈负相关性;Treg、TGF-β1与NIHSS、住院天数呈负相关性,而与ADL呈正相关性(P<0.05)。结论 Th17过亢及Treg不足是颅内动脉瘤全身免疫炎症反应的重要特征,且与患者的预后密切相关,检测两者及其细胞因子有助于评估动脉瘤破裂患者的预后。

Objective To observe the dynamic changes of Th17/Treg balance in patients following surgical intervention for intracranial aneurysm rupture. Methods The percentage of Th cells and the intracellular IL-17 level, Treg cell percentage and transforming growth factor-β1(TGF-β1) levels were examined in 73 patients with rupture of aneurysms before and at 24 h, 72 h and 1 week after operation, with 62 patients with unruptured aneurysms and 65 healthy volunteers as the control. The correlations among the immune cells, cytokines and clinical characteristics of the patients(NIHSS, ADL and hospitalization stay) were analyzed. Results Th17 percentage and intracellular IL-17 levels were significantly higher in the patients with ruptured and unruptured aneurysms than in the healthy volunteers, and were significantly higher in patients with ruptured aneurysms than in those with unruptured aneurysms. Treg cell percentage and TGF-β1 level were significantly lower in patients with aneurysms than in the healthy volunteers, and were lower in patients with ruptured aneurysms than in those with uruptured aneurysms(P<0.05). Patients with intracranial aneurysm rupture showed significantly increased Th17 cell percentage and IL-17 level but significantly lowered Treg cell percentage and TGF-β1 at 24 h following the surgery(P<0.05);these changes were reversed significantly at 72 h and 1 week after the surgery. Th17 cell percentage and IL-17 level were positively correlated with NIHSS and the length of postoperative hospital stay but inversely correlated with ADL; Treg cell percentage and TGF-β1 were inversely correlated with NIHSS and hospital stay but positively with ADL(P<0.05). Conclusion In patients with intracranial aneurysms, the systemic immune inflammatory response is highlighted by excessive Th17 cells and insufficient Treg cells, which are closely related with the outcomes of the patients following surgical intervention.Evaluation of Th17/Treg balance and the cytokine levels can help to assess the prognosis of patients with aneurysm rupture.