耐药型癫痫患者T淋巴细胞亚群、细胞因子变化及其与认知功能、预后的关系研究

Study on the Changes of T Lymphocyte Subpopulations and Cytokines in Drug-resistant Epilepsy Patients and Their Rlationship with Cognitive Function and Prognosis

目的:探究耐药型癫痫患者外周血T淋巴细胞亚群和细胞因子的变化及与认知功能和预后的关系。方法:选择2022年4月至2023年5月本院收治的100例耐药型癫痫患者,根据药物敏感性分为耐药型癫痫组(45例)、药物敏感型癫痫组(55例),选择同期体检的50例健康者作为对照组。采用蒙特利尔认知功能评估量表(MoCA)、临床记忆量表(CMS)和数字符号转换测验评估患者整体智能、记忆功能和注意力,同时检测患者外周血T淋巴细胞亚群分布及白细胞介素-1β(IL-1β)、IL-6和肿瘤坏死因子α(TNF-α)等细胞因子水平。采用Spearman相关性分析对耐药型癫痫患者认知功能指标和T细胞亚群、细胞因子间的相关性进行分析。将耐药型癫痫患者分为预后不良组和预后良好组,比较两组患者外周血T淋巴细胞亚群分布以及IL-1β、IL-6和TNF-α水平。结果:(1)耐药型组和药物敏感型组MoCA评分、记忆商(MQ)和DST评分均显著低于对照组(P<0.05),耐药型组MoCA评分、MQ和DST评分均显著低于药物敏感型组(P<0.05);(2)耐药型组和药物敏感型组外周血CD4+和CD8+百分比显著低于对照组,IL-1β、IL-6和TNF-α水平均显著高于对照组(P<0.05),耐药型组外周血CD4+和CD8+百分比显著低于药物敏感型组,IL-1β、IL-6和TNF-α水平均显著高于药物敏感型组(P<0.05);(3)Spearman分析结果显示,外周血CD4+细胞分布与耐药型癫痫患者Mo CA评分、MQ和DST评分间显著正相关,IL-1β与MoCA评分、MQ和DST评分间显著负相关,IL-6和TNF-α与MoCA评分和MQ显著负相关(P<0.05),CD8+细胞分布与耐药型癫痫患者MoCA评分、MQ和DST评分间以及IL-6和TNF-α与DST评分无显著相关性(P>0.05);(4)预后不良的耐药型癫痫患者外周血CD4+、CD8+细胞比例显著低于预后良好患者,IL-1β、IL-6和TNF-α水平显著高于预后良好患者(P<0.05)。结论:耐药型癫痫患者存在T淋巴细胞亚群分布和细胞因子表达异常,并与患者智能、记忆功能和注意力降低有关。

Objective:To investigate the changes in peripheral blood T lymphocyte subsets and cytokines in drug-resistant epilepsy patients and their relationship with cognitive function and prognosis.Methods:100 drug-resistant epilepsy patients admitted to our hospital from April 2022 to May 2023 were selected and divided into drug-resistant epilepsy group(45 cases)and drug-sensitive epilepsy group(55 cases)based on drug sensitivity.50 healthy individuals who underwent physical examination during the same period were selected as the control group.Using the Montreal Cognitive Function Assessment Scale(MoCA),Clinical Memory Scale(MQ),and Number Symbol Conversion Test to assess overall intelligence,memory function,and attention in patients,while also detecting the distribution of peripheral blood T lymphocyte subpopulations and interleukin-1 in patientsβ(IL-1β),IL-6 and tumor necrosis factorα(TNF-α)levels.The correlation between cognitive function indicators,T cell subpopulations,and cytokines in drug-resistant epilepsy patients was analyzed using Spearman correlation analysis.Results:(1)The MoCA score,MQ and DST scores of the drug resistant and drug sensitive groups were lower than those of the control group(P<0.05),while the MoCA score,MQ and DST scores of the drug resistant group were lower than those of the drug sensitive group(P<0.05);(2)The percentages of CD4+and CD8+in peripheral blood of the drug resistant and drug sensitive groups were lower than those of the control group,the levels of IL-1β、IL-6 and TNF-αThe levels were higher than those of the control group(P<0.05),and the percentages of CD4+and CD8+in peripheral blood of the drug resistant group were lower than those of the drug sensitive group,the levels of IL-1β,IL-6 and TNF-αwere higher than those of the drug sensitive group(P<0.05);(3)Spearman analysis results showed that the distribution of CD4+cells in peripheral blood was significantly positively correlated with MoCA score,MQ and DST score in drug-resistant epilepsy patients,while IL-1βwas negatively correlated with MoCA score,MQ and DST score,IL-6 and TNF-αwere negatively correlated with MoCA score and MQ score(P<0.05).The distribution of CD8+cells was not significantly correlated with MoCA score,MQ and DST score,as well as IL-6 and TNF-αwith DST score in drug-resistant epilepsy patients(P>0.05);(4)The proportion of CD4+and CD8+cells in peripheral blood of drug-resistant epilepsy patients with poor prognosis was lower than that of patients with good prognosis,the levels of IL-1β,IL-6 and TNF-αwere higher than that of patients with good prognosis(P<0.05).Conclusion:Patients with drug-resistant epilepsy exhibit abnormal distribution of T lymphocyte subpopulations and cytokine expression,which are associated with decreased intelligence,memory function,and attention.