急性脑梗死患者外周血调节性T细胞及炎性因子表达水平与临床预后的相关性研究

Correlations of Expression Level of Regulatory T Cells and Inflammatory Factors in Peripheral Blood and Clinical Prognosis in Patients with Acute Cerebral Infarction

目的探讨急性脑梗死(ACI)患者外周血调节性T细胞(Treg)及炎性因子表达水平与临床预后的相关性。方法收集首发ACI患者175例(ACI组)进行前瞻性分析,同期选取46例健康体检者作为对照组。ACI组于入院后第2天采集新鲜外周血标本,对照组于体检时采集。采用流式细胞仪检测外周血CD4^(+)CD25^(+)CD127(low)Treg占CD4^(+)淋巴细胞总数的百分比(Treg%)。采用酶联免疫吸附法或免疫散射比浊法检测白介素(IL)-6、IL-10、超敏C反应蛋白(hs CRP)水平。结果ACI组90 d随访,多因素Logistic回归分析显示IL-6(P=0.034)、hs CRP(P=0.02)是影响ACI 90d预后不良的主要危险因素,ROC分析显示IL-6联合hsCRP水平预测90d预后不良的曲线下面积为0.921(95%CI:0.866~0.976,P=0.000);2年随访时,经调整年龄、房颤史、吸烟史、饮酒史、同型半胱氨酸、高血压病病史后,多因素Logistic回归分析提示Treg%(OR=2.475,95%CI:1.120~4.307,P=0.02)为ACI患者复发的独立危险因素。结论IL-6、hsCRP可作为ACI预后不良的早期标志物,Treg%可作为评估脑梗死复发风险的预测因子。

Aim To investigate the correlation between the expression levels of regulatory T cells(Treg)and inflammatory factors in peripheral blood and clinical prognosis of patients with acute cerebral infarction.Methods A total of 175 patients with acute cerebral infarction were prospectively analyzed,and 46 healthy subjects as the control group.Blood samples were collected on the second day after admission.The percentage of CD4^(+)CD25^(+)CD127(low)regulatory T cells(Treg%)in the total number of CD4^(+)lymphocytes(Treg%)was detected by flow cytometry.The levels of IL-6,IL-10 and hypersensitive C-reactive protein(hs CRP)were detected by ELISA or immunonephelometry.Results Follow up for 90 d,multivariate Logistic regression analysis showed that IL-6(OR=1.78,95%CL:1.235-4.953,P=0.034)and hs CRP(OR=2.165,95%CL:1.638-2.861,P=0.02)were the main risk factors affecting the poor prognosis of cerebral infarction.ROC curve analysis showed that IL-6 combined with hs CRP predicted the area under the curve for poor prognosis was 0.921(95%CI:0.866-0.976,P=0.000);Following up for 2 years,multivariate Logistic regression analysis showed that Treg%(OR=2.475,95%CI:1.120-4.307,P=0.02)was an independent risk factor for stroke recurrence after adjusting for age,atrial fibrillation,smoking,drinking,homocysteine and hypertension.Conclusion IL-6 and hs CRP can be used as early markers of poor prognosis of cerebral infarction.Treg can predict and evaluate the risk of stroke after cerebral infarction.