T淋巴细胞亚群和细胞因子与耐药型癫痫患者认知功能的相关性分析

Analysis of the relationship between T Lymphocyte subsets,cytokines and cognitive function in patients with drug resistant epilepsy

目的分析耐药型癫痫(DRE)患者血清T淋巴细胞亚群及细胞因子水平与认知情绪损伤之间的相关性,探讨相关免疫炎症指标在认知及情绪损伤中的作用。方法选取2020年11月至2021年7月至徐州医科大学附属医院神经内科就诊的58例癫痫患者及性别、年龄、受教育程度无差异的健康对照组30名纳入研究,将癫痫患者分为DRE组、药物敏感型癫痫(DSE)组,对三组受试者进行蒙特利尔认知评估量表(MoCA)、临床记忆量表(MQ)、数字符号转换测试、Stroop字色干扰实验、焦虑自评量表(SAS)、抑郁自评量表(SDS)等量表评分,进行血清T淋巴细胞亚群、细胞因子水平测量,并进行免疫炎症指标与神经心理学量表评分结果的相关性分析。采用单因素方差分析、LSD检验、Kruskal-Wallis H检验、Nemenyi检验、Spearman相关性分析进行统计分析。结果DRE组患者CD4^(+)、CD8^(+)水平均明显低于健康对照组及DSE组患者,DSE组患者CD4^(+)、CD8^(+)水平均明显低于健康对照组(均P<0.05)。DRE组患者IL-1β、IL-6、TNF-α水平均明显高于健康对照组及DSE组患者,DSE组患者IL-1β、IL-6、TNF-α水平均明显高于健康对照组(均P<0.05)。DRE组患者MoCA、MQ、数字符号测试、Stroop(色)得分均明显低于健康对照组及DSE组患者,DSE组患者MoCA、MQ、数字符号测试、Stroop(色)得分均明显低于健康对照组(均P<0.05)。DRE组患者SAS、SDS均明显高于健康对照组及DSE组患者,DSE组患者SAS、SDS均明显高于健康对照组(均P<0.05)。DSE组免疫炎症指标与神经心理学量表评分之间相关性无统计学意义。DRE组CD4^(+)与MoCA、MQ、数字符号、Stroop(色)之间均存在明显的正相关(均P<0.05);IL-1β、IL-6、TNF-α与MoCA、MQ之间均存在明显的负相关(均P<0.05);IL-1β、IL-6、TNF-α与SDS之间均存在明显的正相关(均P<0.05)。结论DRE患者存在着T淋巴细胞亚群紊乱、慢性炎症反应,其与癫痫合并认知及情绪损伤相关,包括整体认知功能、记忆力、注意力、执行功能受损,焦虑及抑郁程度升高。免疫炎症指标可能在DRE患者认知及情绪障碍中发挥重要作用。

Objective To analyze the correlation between the levels of serum T lymphocyte subsets,cytokines and cognitive and emotional impairment in patients with drug resistant epilepsy(DRE),and to explore the role of related immune inflammatory indexes in cognitive and emotional impairment.Methods A total of 58 patients with epilepsy and 30 healthy controls with no difference in sex,age and education were selected from November 2020 to July 2021 in the department of neurology of the Affiliated Hospital of Xuzhou Medical University.Patients with epilepsy were divided into DRE group and drug sensitive epilepsy(DSE)group,the subjects in three groups were scored by Montreal cognitive assessment(MoCA),clinical memory inventory(MQ),digital symbol substitution test,Stroop color word test,self-rating anxiety scale(SAS)and self-rating depression scale(SDS).The levels of serum T lymphocyte subsets and cytokines were measured,and the correlation between immune inflammation and neuropsychological scale scores was analyzed.One-way ANOVA,LSD test,Kruskal-Wallis H test,Nemenyi test and Spearman correlation analysis were used for statistical analysis.Results The levels of CD4^(+)and CD8^(+)in DRE group were significantly lower than those in healthy control group and DSE group,and the levels of CD4^(+)and CD8^(+)in DSE group were significantly lower than those in healthy control group(allP<0.05).The levels of IL-1β,IL-6and TNF-αin DRE group were significantly higher than those in healthy control group and DSE group,and the levels of IL-1β,IL-6 and TNF-αin DSE group were significantly higher than those in healthy control group(allP<0.05).The scores of MoCA,MQ,digital symbol substitution test and Stroop(color)in DRE group were significantly lower than those in healthy control group and DSE group,while the scores of MoCA,MQ,digital symbol substitution test and Stroop(color)in DSE group were significantly lower than those in healthy control group(allP<0.05).The levels of SAS and SDS in DRE group were significantly higher than those in healthy control group and DSE group,and the levels of SAS and SDS in sensitive patients were significantly higher than those in healthy control group(allP<0.05).There was no significant correlation between the index of immune inflammation and the score of neuropsychological scale in DSE group.In DRE group,there was significant positive correlation between CD4^(+)and MoCA,MQ,digital symbol substitution test and Stroop(color)(allP<0.05),negative correlation between IL-1β,IL-6,TNF-αand MoCA,MQ(allP<0.05)and significant positive correlation between IL-1β,IL-6,TNF-αand SDS(allP<0.05).Conclusions There are disorders of T lymphocyte subsets and chronic inflammation in patients with drug-resistant epilepsy,which are associated with cognitive and emotional impairment,including impairment of overall cognitive function,memory,attention,executive function,increased anxiety and depression.Immune inflammatory markers may play an important role in cognitive and emotional disorders in patients with drug-resistant epilepsy.