高压氧辅助治疗对病毒性脑炎患儿疗效及其作用机制

Clinical efficacy and mechanism of action of hyperbaric oxygen as adjuvant therapy on children with viral encephalitis

目的探究高压氧(HBO)辅助治疗对病毒性脑炎患儿疗效及辅助性T细胞17(Th17)/调节性T细胞(Treg)和淋巴细胞中Notch通路的影响。方法选取2017年3月至2019年3月西南医科大学附属医院收治的78例病毒性脑炎患儿作为研究对象,采用随机数字表法分为2组,每组39例。对照组患儿接受常规治疗,HBO组在对照组治疗基础上联合HBO治疗。比较2组治疗效果和简易精神状态评价量表(MMSE)评分。分析外周血中Th17和Treg细胞水平和淋巴细胞中Notch通路水平。结果HBO组总有效率[94.87%(37/39)]显著高于对照组[74.36%(29/39)],临床症状缓解时间、癫痫发作次数和脑脊液中淋巴细胞数显著少于对照组,MMSE评分显著高于对照组,差异均有统计学意义(P<0.05)。对照组和HBO组治疗后Th17细胞以及相关因子水平降低,而Treg细胞以及相关因子水平升高,与治疗前相比差异均有统计学意义(P<0.05)。HBO组治疗后的Th17/Treg比例和Th17相关因子水平显著低于对照组,而Treg相关因子水平显著高于对照组,差异均有统计学意义(P<0.05)。治疗后2组Notch通路水平均下调,差异有统计学意义(P<0.05);HBO组淋巴细胞的Notch1、Hes1和Hey1蛋白水平均显著低于对照组,差异有统计学意义(P<0.05)。结论HBO可能是通过调节Notch通路使Th17/Treg平衡向Treg偏移,从而提高对病毒性脑炎患儿的治疗效果。

Objective To investigate the clinical efficacy of hyperbaric oxygen(HBO)as adjuvant therapy on children with viral encephalitis(VE),and its effect on the pathway of T helper 17(Th17)cells/regulatory T(Treg)cells and Notch signaling pathway in lymphocytes.Methods A total of 78 children with VE treated in the Affiliated Hospital of Southwest Medical University from March 2017 to March 2019 were divided into two groups by the random number table method,with 39 cases in each group.The control group received conventional treatment,and the HBO group was treated with HBO on the basis of the treatment of the control group.The therapeutic effects and scores of Mini-mental State Examination(MMSE)of the two groups were compared.The levels of Th17 cells and Treg cells in peripheral blood and the level of Notch signaling in lymphocytes were analyzed.Results The total effective rate of the HBO group(94.87%,37/39)was significantly higher than that of the control group(74.36%,29/39);the time period to clinical symptom relief,the number of seizures,and the count of lymphocytes in cerebrospinal fluid of the HBO group were significantly lower than those of the control group;and the MMSE score of the HBO group was significantly higher than that of the control group;all the differences above were statistically significant(P<0.05).After treatment,the levels of Th17 cells and its related factors were significantly decreased,while the levels of Treg cells and its related factors were significantly increased(P<0.05).After treatment,the ratio of Th17 cells/Treg cells and the levels of Th17-related factors in the HBO group were significantly lower than those in the control group(P<0.05),while the levels of Treg-related factors in the HBO group were significantly higher than those in the control group(P<0.05).After treatment,the levels of Notch signaling were significantly decreased in both groups(P<0.05).After treatment,the expressions of the Notch1,Hes1,and Hey1 in lymphocytes of the HBO group were significantly lower than those in the control group(P<0.05).Conclusion HBO may improve its clinical efficacy in treating children with VE by modulating the Notch signaling pathway to shift the Th17/Treg balance toward Treg.