出生早期外周血γδ-T淋巴细胞亚群与早产儿脑损伤的相关性研究

The correlation between γδ-T lymphocyte subset in early postnatal peripheral blood and brain injury of preterm infants

目的分析早产儿出生早期外周血中γδ-T淋巴细胞亚群的水平与脑损伤的关系, 探讨外周血淋巴细胞亚群对早产儿脑损伤的早期预测价值。方法采用前瞻性研究方法, 选取2021年1月1日至6月1日在郑州大学第三附属医院新生儿科住院的106例胎龄<34周的早产儿为研究对象, 采用流式细胞术检测其出生24 h外周血γδ-T、CD4+T、CD8+T、CD3+T及总淋巴细胞的比例, 根据出生后连续头颅超声及纠正胎龄36~37周头颅磁共振成像检查结果, 将患儿分为脑损伤组(36例)及无脑损伤组(70例), 采用t检验或χ2检验比较2组患儿一般情况及淋巴细胞亚群的差异;将脑损伤组进一步按照不同脑损伤类型分为颅内出血组(8例)、脑室周围白质软化组(6例)及弥散性脑白质损伤组(22例), 采用单因素方差分析和LSD-t检验比较各组间淋巴细胞亚群的差异。结果脑损伤组早产儿出生24 h外周血中γδ-T淋巴细胞水平[(0.09±0.12)%]低于无脑损伤组早产儿[(0.15±0.13)%], 差异有统计学意义(t=-2.445, P=0.016), 2组早产儿CD4+、CD8+等T淋巴细胞亚群无差异。脑损伤组患儿中, 脑室周围白质软化组或弥散性脑白质损伤组早产儿出生24 h外周血γδ-T淋巴细胞占比[(0.03±0.05)%、(0.07±0.09)%]低于无脑损伤组早产儿[(0.15±0.13)%], 差异均有统计学意义(t=-2.190、-2.659, 均P<0.05)。结论γδ-T淋巴细胞可能与早产儿脑损伤的发生有关;出生早期外周血γδ-T淋巴细胞对早产儿脑损伤, 特别是脑白质软化及弥散性脑白质损伤具有预测价值。

Objective To investigate the correlation between preterm infants with brain injury and the proportion of lymphocyte subsets,especiallyγδ-T cells in the postnatal peripheral blood,and to determine the predictive potential ofγδ-T cells in the early peripheral blood in brain injury.Methods It was a prospective study involving 106 preterm infants with gestational age less than 34 weeks who were delivered in the Department of Neonatology,the Third Affiliated Hospital of Zhengzhou University from January 1,to June 1,2021.Relative levels ofγδ-T,CD4+T,CD8+T,CD3+T and total lymphocyte subsets in peripheral blood collected within the first 24 hours after birth were measured by flow cytometry.Recruited infants were divided into brain injury group(36 cases)and non-brain injury group(70 cases)according to serial cranial ultrasound and magnetic resonance imaging(MRI)at the corrected gestational age of 36-37 weeks.Differences in general conditions and the proportion of lymphocyte subsets between groups were compared by the t-test or Chi-square test.Patients in brain injury group were further divided into intracranial hemorrhage(ICH)group(8 cases),periventricular leukomalacia(PVL)group(6 cases)and diffuse white matter damage(WMD)group(22 cases).The proportion of lymphocyte subsets among the different groups was compared by One-Way ANOVA,followed by the LSD-t test.Results The proportion ofγδ-T cells in postnatal peripheral blood of preterm infants at 24 hours after birth in brain injury group was significantly lower than that of non-brain injury group[(0.09±0.12)%vs.0.15±0.13)%,t=-2.445,P=0.016].No significant differences in the proportion of the CD4+and CD8+T cell subsets were found between them.Both preterm infants in PVL group and WMD group had a significantly lower proportion ofγδ-T cells at 24 hours after birth compared to that of the non-brain injury group[(0.03±0.05)%,(0.07±0.09)%and(0.15±0.13)%],respectively,(t=-2.190,-2.659,all P<0.05).Conclusionsγδ-T cells in early postnatal peripheral blood may be involved in the development of brain injury in preterm infants and they had early predictive value for preterm infants at high risk of brain injury,especially the leukomalacia and diffuse white matter injury.