帕金森吞咽障碍患者肺部感染病原学及Th17/Treg和Th1/Th2变化

Study on etiological characteristics of lung infection and changes in Th17/Treg and Th1/Th2 levels in patients with Parkinson′s swallowing disorder

目的探讨帕金森吞咽障碍患者肺部感染病原特点及辅助型T细胞17/调节型T细胞(Th17/Treg)、辅助型T细胞1/辅助型T细胞2(Th1/Th2)改变研究。方法选择牡丹江医学院附属红旗医院神经科2017年5月-2019年5月收治的帕金森吞咽障碍患者100例作为研究对象,根据其是否发生肺部感染分为感染组(n=42)及非感染组(n=58)。对感染组患者病原分布特点进行调查,采用流式细胞术对患者外周血中Th17/Treg、Th1/Th2占CD4+T淋巴细胞比例进行研究,采用酶联免疫吸附法对患者血清中白细胞介素-17(IL-17)、IL-23、转化生长因子-β(TGF-β)、干扰素-γ(IFN-γ)、IL-4、IL-5进行检测。结果感染组42例患者共检出肺部感染病原菌47株,其中革兰阴性菌29株占61.70%,革兰阳性菌14株占29.79%,真菌4株占8.51%;感染组外周血Th17细胞、血清IL-17、IL-23水平高于非感染组,外周血Treg细胞、血清TGF-β低于非感染组,差异均具有统计学意义(P<0.05);感染组外周血Th1细胞、血清IFN-γ水平高于非感染组,外周血Th2细胞、血清IL-4、IL-5低于非感染组,差异均具有统计学意义(P<0.05)。结论帕金森吞咽障碍患者肺部感染病原菌以革兰阴性菌为主,伴随着明显的Th17/Treg、Th1/Th2免疫平衡向Th17、Th1促炎的方向失衡,其作为免疫靶点的进一步应用仍有待研究。

OBJECTIVE To explore the pathogenic characteristics of pulmonary infection and the changes in helper T cells 17/regulatory T cells(Th17/Treg), helper T cells 1/helper T cells 2(Th1/Th2) in patients with Parkinson′s swallowing disorder. METHODS Total of 100 patients with Parkinson′s dysphagia who were treated in the Department of Neurology of Hongqi Hospital affiliated to Mudanjiang Medical College from May 2017 to May 2019 were recruited as the research subjects. They were divided into the infection group(42 cases) and non-infection group(58 cases) according to whether or not they had pulmonary infection. The distribution characteristics of the pathogens in the infected group were investigated. The ratio of Th17/Treg and Th1/Th2 to CD4+ T lymphocytes in the peripheral blood of patients was detected by flow cytometry. The serum level of interleukin-17(IL-17) in patients was measured by enzyme-linked immunosorbent assay. IL-17, IL-23, transforming growth factor-β(TGF-β), interferon-γ(IFN-γ), IL-4, IL-5 were also detected. RESULTS A total of 47 strains were detected in 42 patients, of which 29 were Gram-negative bacteria, accounting for 61.70%, 14 were Gram-positive bacteria, accounting for 29.79%, 4 were fungi, accounting for 8.51%;peripheral blood Th17 cells, serum IL-17, IL-23 levels in the infection group were higher than that in the non-infection group. Peripheral blood Treg cells and serum TGF-β levels in the infection group were lower than that in non-infected PD patients, and the differences were significant(P<0.05). Th1 cells in peripheral blood and serum IFN-γ levels in the infection group were higher than that in the non-infection group, whereas the levels of peripheral blood Th2 cells, serum IL-4, IL-5 was lower than that in the non-infection group, and the differences were significant(P<0.05). CONCLUSION Pulmonary infections in patients with Parkinson′s swallowing disorder are mainly caused by Gram-negative bacteria, accompanied by a significant imbalance of Th17/Treg and Th1/Th2 immune balance in the direction of Th17 and Th1 proinflammatory, and its further application as an immune target remains to be studied.