T淋巴细胞亚群水平对脑卒中后癫痫的预测价值

The predictive value of T lymphocyte subsets in epilepsy after stroke

目的探讨T淋巴细胞亚群水平对脑卒中后癫痫的预测价值。方法选取2018年3月至2020年3月新疆维吾尔自治区人民医院收治的280例脑卒中患者为研究对象,根据有无脑卒中后癫痫发作将其分为脑卒中后癫痫组(146例)和脑卒中后非癫痫组(134例),选取同期于该院体检的140例健康人纳入对照组,比较三组研究对象外周血T淋巴细胞亚群(CD4^(+)T淋巴细胞、CD8^(+)T淋巴细胞、CD4^(+)T/CD8^(+)比值)水平,采用Logistic回归分析影响脑卒中后癫痫发生的相关危险因素,绘制受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)评价T淋巴细胞亚群水平预测脑卒中后癫痫的临床价值。结果脑卒中后非癫痫组和脑卒中后癫痫组患者年龄、性别、合并疾病、梗死部位、美国国立卫生研究院卒中量表评分比较差异均无统计学意义(均P>0.05);脑卒中后癫痫组患者外周血CD4^(+)T淋巴细胞水平、CD4^(+)/CD8^(+)比值均显著低于脑卒中后非癫痫组和对照组(均P<0.05),CD8^(+)T淋巴细胞水平均显著高于脑卒中后非癫痫组和对照组(均P<0.05);Logistic回归分析结果显示,外周血CD4^(+)T淋巴细胞<43.55%、CD8^(+)T淋巴细胞>26.40%和CD4^(+)/CD8^(+)比值<1.82均是脑卒中后发生癫痫的独立影响因素(均P<0.05);ROC曲线结果显示,外周血CD4^(+)T淋巴细胞、CD8^(+)T淋巴细胞和CD4^(+)/CD8^(+)比值联合预测脑卒中后癫痫发生的曲线下面积为0.876,灵敏度和特异度分别为95%、76%。结论脑卒中后癫痫发作与外周血T淋巴细胞亚群水平变化密切相关,且T淋巴细胞亚群水平可作为预测脑卒中后癫痫发作的血清学标志物。

Objective To explore the predictive value of T lymphocyte subsets level in epilepsy after stroke.Method A total of 280 stroke patients admitted to the People’s Hospital of Xinjiang Uygur Autonomous Region from March 2018 to March 2020 were selected as the research objects,and they were divided into post-stroke epilepsy group(146 cases)and non-post-stroke epilepsy group(134 cases)according to the presence or absence of post-stroke epilepsy,and 140 healthy people who were in the hospital for physical examination during the same period were selected into control group.The levels of peripheral blood T lymphocyte subsets(CD4^(+)T lymphocyte,CD8^(+)T lymphocyte,CD4^(+)/CD8^(+)ratio)among the three groups were compared.Logistic regression was used to analyze the risk factors of epilepsy after stroke.The clinical value of T lymphocyte subsets in predicting epilepsy after stroke was evaluated by receiver operating characteristic curve(ROC curve).Result There were no significant differences in the age,sex,comorbidity,location of infarction,and the scores of National Institute of Health stroke scale between post-stroke epilepsy group and non-poststroke epilepsy group(all P>0.05).The levels of CD4^(+)T lymphocyte and CD4^(+)/CD8^(+)ratio in peripheral blood of patients with poststroke epilepsy group were significantly lower than those of non-post-stroke epilepsy group and control group(all P<0.05),the levels of CD8^(+)T lymphocyte in peripheral blood were significantly higher than non-post-stroke epilepsy group and control group(all P<0.05).Logistic regression analysis showed that CD4^(+)T lymphocyte<43.55%,CD8^(+)T lymphocyte>26.40%and CD4^(+)/CD8^(+)ratio<1.82 in peripheral blood were independent influencing factors of epilepsy after stroke(all P<0.05).The ROC curve results show that the area under the curve of peripheral blood CD4^(+)T lymphocyte,CD8^(+)T lymphocyte and CD4^(+)/CD8^(+)ratio combined to predict epilepsy after stroke was 0.876,and the sensitivity and specificity were 95%and 76%,respectively.Conclusion Epileptic seizures after stroke are closely related to changes in peripheral blood T lymphocyte subsets levels,and T lymphocyte subsets levels can be used as serum markers to predict seizures after stroke.