急性缺血性脑卒中患者外周血Th17/Treg细胞亚群水平的变化及临床意义

Changes and Clinical Significance of Th17/Treg Cell Subsets in Peripheral Blood of Patients with Acute Ischemic Stroke

目的:探讨外周血辅助性T细胞-17(Th17)/调节性T细胞(Treg)细胞亚群在急性缺血性脑卒中(AIS)患者的水平变化及临床意义。方法:符合纳入标准的AIS患者190例纳入观察组,健康体检者60例纳入对照组;根据美国国立卫生院脑卒中量表(NIHSS)评分将观察组分为轻度亚组61例,中度亚组64例,重度亚组65例;根据m RS评分纳入预后良好亚组139例,纳入预后不良亚组51例。采用流式细胞仪检测并比较各(亚)组外周血Th17/Treg细胞水平,酶联免疫吸附法检测并比较相关细胞因子(IL-17,TGF-β);评价Th17/Treg细胞亚群水平对AIS患者预后不良的预测价值。结果:观察组患者外周血Th17、Th17/Treg比值及IL-17水平明显高于对照组(P<0.05),Treg细胞亚群和TGF-β水平显著低于对照组(P<0.05)。外周血Th17、Th17/Treg比值及IL-17水平比较,重度亚组最高,中度亚组次之,轻度亚组最低(P<0.05);Treg细胞亚群和TGF-β水平比较,重度亚组最低,中度亚组次之,轻度亚组最高(P<0.05)。预后不良组患者外周血Th17、Th17/Treg比值及IL-17水平明显高于预后良好组(P<0.05),Treg细胞亚群和TGF-β水平显著低于预后良好组(P<0.05)。ROC曲线分析显示,外周血Th17细胞和Treg细胞水平对AIS患者预后不良预测的敏感性分别为78.01%和79.17%,特异性分别为82.50%和74.50%。结论:外周血Th17/Treg细胞亚群与AIS的病情严重程度及预后密切相关,对于AIS患者病情严重程度及预后的评估,具有一定的临床应用价值。

Objective:To investigate the changes and clinical significance of the levels of Th17/Treg cell subsets in peripheral blood of patients with acute ischemic stroke(AIS).Methods:Based on fulfillment of recruitment requirements,190 AIS patients were included in the observation group and 60 healthy subjects into the control group.AIS patients were further divided according to the NIH Stroke Scale(NIHSS)into the mild subgroup(61 cases),moderate subgroup(64 cases),and severe subgroup(65 cases).The observation group was also divided according to the modified Rankin Scale(mRS)score into the good prognosis subgroup(139 cases)and poor prognosis subgroup(51 cases).The levels of Th17/Treg cells in the peripheral blood of AIS patients and healthy subjects were detected by flow cytometry.The related cytokines(IL-17,TGF-β)were detected by enzyme-linked immunosorbent assay.The differences in the above indicators were compared in the different severity subgroups and prognostic subgroups,and the predictive value of Th17/Treg cell levels for poor prognosis in patients with AIS was evaluated.Results:The peripheral blood levels of Th17,Th17/Treg cell ratio,and IL-17 in the observation group were significantly higher than those in the control group(P<0.05),while the levels of Treg cell subsets and TGF-βwere significantly lower than those in the control group(P<0.05).The Th17,Th17/Treg cell ratio,and IL-17 levels in the severe subgroup were the highest;those in the moderate subgroup were the second;and those in the mild subgroup were the lowest(P<0.05).The levels of Treg cells and TGF-βin the severe subgroup were the lowest,the moderate subgroup the second,and the mild group the highest(P<0.05).The peripheral blood levels of Th17,Th17/Treg cell ratio,and IL-17 in the poor prognosis subgroup were significantly higher than those in the good prognosis subgroup(P<0.05),while the levels of Treg cell subsets and TGF-βwere significantly lower than those in the good prognosis subgroup(P<0.05).ROC curves analysis showed that Th17 cell and Treg cell levels in peripheral blood had 78.01%and 79.17%sensitivity and 82.50%and 74.50%specificity,respectively,in predicting poor prognosis in patients with AIS.Conclusion:The Th17/Treg cell subsets in peripheral blood are closely related to the severity and prognosis of AIS,and they have certain value in clinical application for the assessment of severity and prognosis in AIS patients.