急性缺血性卒中早期外周血Th17/Treg失衡情况及与预后的关系

Imbalance of Th17/Treg in Peripheral Blood of Acute Ischemic Stroke Patients and Its Rela tionship with Prognosis

目的:探讨急性缺血性卒中(AIS)早期外周血辅助性T细胞17(Th17)和调节性T细胞(Treg)比值及其与发病90 d预后的关系.方法:AIS患者64例纳入AIS组,健康体检者40例纳入对照组.采用流式细胞仪测定并比较外周血Th17、Treg细胞水平和Th17/Treg比值.根据90 d后改良Rankin量表(mRS)评分,将患者分为预后良好37例及预后不良组27例.比较不同预后组患者的临床资料;Spearman分析Th17/Treg与病情严重程度的相关性;多因素Logistics回归分析AIS患者90 d预后不良发生的影响因素;受试者工作特征曲线评价入院时Th17/Treg水平对AIS患者进行预后的评估效率.结果:AIS组外周血Th17比例增高,Treg比例降低,Th17/Treg明显高于对照组(均P<0.05).预后不良组入院时外周血Th17/Treg、白细胞介素(interleukin,IL)-6水平、梗死灶体积和NIHSS评分均高于预后良好组(均P<0.01).IL-6、NIHSS及梗死体积与Th17/Treg正相关(P<0.001).梗死灶体积和Th17/Treg是AIS患者90 d预后不良发生的独立影响因素(P<0.05).Th17/Treg预测AIS患者预后的ROC曲线下面积为0.898(95%CI:0.828~0.971,P=0.000).Th17/Treg最有效的截断值为3.775,此时预测敏感性为66.7%,特异性为97.3%.结论:AIS患者早期外周外周血Th17/Treg增加,并对不良预后有一定的预测价值.

Objective:To investigate the early-stage Th17/Treg ratio in the peripheral blood of acute ischemic stroke(AIS)patients and its relationship with 90-day prognosis.Methods:We assigned 64 patients with AIS and 40 healthy controls to the AIS group and control group,respectively.The levels of Th17 and Treg cells and the ratio of Th17/Treg in the peripheral blood of all participants were detected by flow cytometry.Patients were divided into the good prognosis group(n=37)and poor prognosis group(n=27)according to the mRS score after 90 days.The clinical data of the two groups were compared.Spearman analysis was used to assess the relationship between Th17/Treg and severity of condition.Multivariate logistic regression analysis was used to examine the influencing factors of a poor 90-day prognosis.The receiver operating characteristic curve(ROC)was used to evaluate the predictive effect of the Th17/Treg ratio at time of admission.Results:The peripheral blood Th17 level was increased,Treg level decreased,and Th17/Treg ratio significantly increased in AIS group patients compared to control group patients(all P<0.05).The poor prognosis group showed significantly higher peripheral blood Th17/Treg,IL-6 level,infarct volume,and NIHSS score compared to the good prognosis group(all P<0.01).IL-6,NIHSS,and infarct volume were positively correlated with Th17/Treg(P<0.001).Infarct volume and Th17/Treg were independent risk factors for a poor 90-day prognosis.The area under the ROC curve for Th17/Treg in predicting AIS prognosis was 0.898(95%CI:0.828~0.971,P=0.000).The optimal cutoff value of Th17/Treg was 3.775 with a sensitivity of 66.7%and a specificity of 97.3%.Conclusion:The early-stage Th17/Treg ratio in peripheral blood increased in patients with AIS and offered a certain predictive value for 90-day poor prognosis.