缺血性脑卒中患者肠道菌群改变与其预后及Th1/Th2免疫细胞平衡的相关性

Intestinal flora changes in patients with ischemic stroke and correlations with prognosis and Th1/Th2 immune cell balance

目的探讨缺血性脑卒中患者肠道菌群改变与其预后及Th1/Th2免疫细胞平衡的相关性。方法选取2020年1月—2022年3月就诊的106例缺血性脑卒中患者为研究对象,均行静脉溶栓治疗,且出院后进行90 d随访,采用改良Rankin量表(Modified Rankin Scale,m RS)评分评估预后,将患者分为良好组(m RS评分≤2分,71例)和不良组(m RS评分为3~6分,35例),对比2组肠道菌群组成、Th1/Th2及相关细胞因子水平,采用Pearson相关性分析,分析缺血性脑卒中患者肠道菌群相对丰度与Th1/Th2及相关细胞因子水平的相关性。结果不良组Chao l指数、Shannon指数低于良好组(t=7.025、5.033,P均<0.001);不良组厚壁菌门、普雷沃菌属低于良好组(t=11.475、6.514,P均<0.001);不良组拟杆菌属、埃希氏菌属高于良好组(t=19.289、7.826,P均<0.001);不良组白细胞介素(interleukin,IL)2、干扰素γ(interferon-γ,IFN-γ)水平高于良好组(t=12.685、25.814,P均<0.001);而Th1/Th2、IL-4、IL-5水平低于良好组(t=5.066、12.793、11.476,P均<0.001)。Pearson相关性分析结果显示,拟杆菌门、埃希氏菌属与Th1/Th2、IL-4、IL-5呈负相关(r=-0.604~-0.376,P均<0.05),与IL-2、IFN-γ呈正相关(r=0.439~0.623,P均<0.05);厚壁菌门、普雷沃菌属、Chao 1指数和Shannon指数与Th1/Th2、IL-4、IL-5呈正相关(r=0.428~0.623,P均<0.05),与IL-2、IFN-γ呈负相关(r=-0.584~-0.397,P均<0.05)。结论缺血性脑卒中患者肠道菌群改变与不良预后、Th1/Th2及相关细胞因子水平相关。

Objective To study intestinal flora changes in patients with ischemic stroke,and to explore their correlations with prognosis and T helper cell type 1/T helper cell type 2(Th1/Th2)immune cell balance.Methods One hundred and six patients with ischemic stroke admitted to our hospital between January 2020 and March 2022 were enrolled and received intravenous thrombolytic therapy.After discharge,the prognosis of patients was evaluated using the Modified Rankin Scale(mRS)after 90-day follow-up.These patients were divided into the good group(mRS score≤2,n=71)and poor group(3<mRS score<6,n=35)according to the mRS score.The intestinal flora composition and levels of Th1/Th2 and related cytokines were compared between the two groups.Pearson correlation analysis was conducted to reveal the correlations between the relative abundance of intestinal flora and the levels of Th1/Th2 and related cytokines in these patients.Results Chaol index and Shannon index were lower in the poor group than in the good group(t=7.025,5.033,all P<0.001).The abundance of Firmicutes and Prevotella was decreased in the poor group(t=11.475,6.514,all P<0.001),while the abundance of Bacteroides and Escherichia was increased compared with the good group(t=19.289,7.826,all P<0.001).The poor group had elevated serum levels of interleukin-2(IL-2)and interferon-γ(IFN-γ)(t=12.685,25.814,all P<0.001)but decreased levels of Th1/Th2,IL-4 and IL-5 compared with the good group(t=5.066,12.793,11.476,all P<0.001).The results of Pearson correlation analysis suggested that Bacteroidetes and Escherichia were negatively correlated with Th1/Th2,IL-4,and IL-5(r=-0.604~-0.376,P<0.05),but positively with IL-2 and IFN-γ(r=0.439~0.623,all P<0.05).Firmicutes,Prevotella,Chao1 index,and Shannon index were positively correlated with Th1/Th2,IL-4,and IL-5(r=0.428~0.623,P<0.05),but negatively with IL-2 and IFN-γ(r=-0.584~-0.397,P<0.05).Conclusion Changes in intestinal flora in patients with ischemic stroke are associated with poor prognosis and levels of Th1/Th2 and related cytokines.