老年血管性痴呆患者外周血辅助性T细胞水平变化及临床意义

Changes of peripheral blood helper T cells in elderly patients with vascular dementia and their clinical significance

目的观察老年血管性痴呆患者外周血辅助性T(Th)细胞水平变化并探讨其临床意义。方法选取徐州市第一人民医院老年医学科自2019年2月至2020年1月收治的96例老年血管性痴呆患者为疾病组,并于同时间段招募92名老年健康志愿者作为健康组,利用流式细胞术检测外周血Th1、Th2、Th17比例,利用酶联免疫吸附试验检测上述细胞因子(IL-2、TNF-α、IL-17、IL-4、IL-10)水平。对比2组患者外周血Th1、Th2、Th17比例及细胞因子水平,并分析比较疾病组不同认知功能障碍程度患者外周血Th1、Th2、Th17比例、细胞因子水平及治疗前后日常生活活动能力(ADL)评分。疾病组均予以常规治疗,随访6个月,统计预后情况,分析外周血Th1、Th2、Th17比例与预后不良的关系。结果疾病组外周血Th1、Th17比例及细胞因子水平均高于健康组,且重度认知功能障碍患者均高于轻度认知功能障碍患者,差异均具有统计学意义(P<0.05)。疾病组外周血Th2比例及细胞因子水平低于健康组,且重度认知功能障碍患者低于轻度认知功能障碍患者,差异均具有统计学意义(P<0.05)。治疗前后疾病组重度认知功能障碍患者ADL评分低于轻度认知功能障碍患者,同组患者治疗后ADL评分较治疗前提高,差异均具有统计学意义(P<0.05)。疾病组外周血Th1、Th17比例及细胞因子IL-2、TNF-α、IL-17水平均与ADL评分呈负相关(P<0.05),外周血Th2比例及细胞因子IL-4、IL-10水平均与ADL评分呈正相关(P<0.05)。疾病组预后不良发生率为29.17%,且高龄、重度认知功能障碍、抽烟、酗酒、外周血Th1和Th17比例是疾病组预后不良的危险因素(P<0.05),外周血Th2比例、治疗依从是其保护因素(P<0.05)。结论老年血管性痴呆患者外周血Th1、Th17比例及细胞因子水平偏高,而Th2比例及细胞因子水平偏低,且与认知功能障碍程度、预后均有关。

Objective To observe the changes of helper T(Th)cells in peripheral blood of patients with senile vascular dementia,and to explore its clinical significance.Methods Ninety six patients with vascular dementia treated in the Geriatrics Department of Xuzhou First People’s Hospital from February 2019 to January 2020 were selected as the disease group,and 92 elderly healthy volunteers were selected as the health group at the same time.The ratios of Th1,Th2 and Th17 were detected by flow cytometry,and the level of cytokines(IL-2,TNF-α,IL-17,IL-4,IL-10)were detected by enzyme-linked immunosorbent assay.The ratios of Th1,Th2,Th17 and level of cytokines in peripheral blood of disease group and healthy group were compared.The ratios of Th1,Th2,Th17 and level of cytokines in peripheral blood and the scores of activity of daily living(ADL)of patients with different degrees of cognitive dysfunction before and after treatment were compared.Patients in the disease group were given conventional treatment.The patients were followed up for 6 months,and the relationships between the ratios of Th1,Th2 and Th17 in peripheral blood and poor prognosis were analyzed.Results The ratios of Th1,Th17 and level of cytokines in peripheral blood of the disease group was higher than that of the healthy group(P<0.05),of which the patients with severe cognitive dysfunction were higher than those with mild cognitive dysfunction(P<0.05).The ratios of Th2 and level of cytokines in peripheral blood of the disease group were lower than those of the healthy group(P<0.05),of which the patients with severe cognitive dysfunction was lower than those with mild cognitive dysfunction(P<0.05).Before and after treatment,the ADL scores of patients with severe cognitive impairment were lower than those of patients with mild cognitive impairment(P<0.05),and the ADL scores of patients after treatment were higher than those before treatment(P<0.05).In the disease group,the ratios of Th1,Th17 and level of cytokines(IL-2,TNF-α,IL-17)in peripheral blood were negatively correlated with ADL scores(P<0.05),and the ratio of Th2 and level of cytokines(IL-4,IL-10)in peripheral blood were positively correlated with ADL scores(P<0.05).The incidence of poor prognosis in the disease group was 29.17%,and the risk factors of poor prognosis in the disease group were age,severe cognitive dysfunction,smoking,alcohol abuse,ratios of Th1 and Th17 in peripheral blood(P<0.05),while the protective factors were Th2 ratio in peripheral blood and treatment compliance(P<0.05).Conclusion The ratio of Th1 and Th17 and level of cytokines in peripheral blood of elderly patients with vascular dementia are high,while the ratio of Th2 and level of cytokines are low,which are related to the degree of cognitive dysfunction and prognosis.