局灶性癫痫患者外周血双阴性T细胞的检测及临床意义

Detection and clinical significance of peripheral blood double⁃negative T cells in patients with focal epilepsy

目的检测局灶性癫痫患者外周血双阴性T细胞(DNT、CD4-CD8-)的表达水平,探讨其在癫痫发病中的临床意义。方法选取2021年11月-2023年3月于徐州医科大学附属医院神经内科就诊、结合临床发作形式及辅助检查诊断为局灶性癫痫的患者89例为研究对象,选取同期健康体检者42人作为对照组。收集研究对象的外周血标本,检测外周血中T淋巴细胞亚群、细胞因子[白细胞介素1β(IL-1β)、IL-2、IL-4、IL-5、IL-6、IL-8、IL-10、IL-12p70、IL-17、干扰素-α(IFN-α)、IFN-γ、肿瘤坏死因子-α(TNF-α)]水平,并进行DNT细胞与细胞因子、T淋巴细胞亚群的相关性分析,采用受试者工作特征(ROC)曲线评价其预测价值。结果局灶性癫痫患者DNT、IL-1β、IL-5、IL-6、IFN-γ、TNF-α水平明显高于对照组,差异均有统计学意义(Z=-6.15、-3.20、-3.09、-3.20、-2.41、-2.44,P均<0.05);两组间IL-2、IL-4、IL-8、IL-10、IL-12p70、IL-17、IFN-α、CD4^(+)、CD8^(+)细胞水平差异均无统计学意义(P均>0.05)。DNT细胞与IL-17、TNF-α成正相关(r=0.221、0.258,P均<0.05),与CD4^(+)成负相关(r=-0.332,P<0.05),与其余指标均无明显相关性(P>0.05)。ROC曲线分析显示,DNT、TNF-α、IL-1β、IL-5、IL-6、IFN-γ以及联合检测诊断局灶性癫痫的曲线下面积分别为0.816、0.785、0.674、0.668、0.674、0.631、0.858,对应的敏感度分别为64.04%、77.53%、64.04%、69.66%、48.31%、68.54%、67.42%,特异度分别为92.31%、69.05%、71.43%、57.14%、83.33%、57.14%、95.24%。结论局灶性癫痫患者外周血DNT细胞水平明显增高,DNT细胞与IL-17、TNF-α、CD4^(+)T细胞有相关性,可能在局灶性癫痫发病机制中参与重要作用。

Objective To investigate the expression level of peripheral blood double⁃negative T cells(DNT,CD4-CD8-)in patients with focal epilepsy and its clinical significance.Methods A total of 89 patients with focal epilepsy were collected from the Department of Neurology,the Affiliated Hospital of Xuzhou Medical University from 2021 to 2023.Forty⁃two healthy individuals during the same period were selected as the control group.Peripheral blood samples were collected from all study subjects to detect the levels of T lymphocyte subsets and cytokines[interleukin⁃1β(IL⁃1β),IL⁃2,IL⁃4,IL⁃5,IL⁃6,IL⁃8,IL⁃10,IL⁃12p70,IL⁃17,interferon⁃α(IFN⁃α),IFN⁃γ,tumor necrosis factor⁃α(TNF⁃α)]in peripheral blood.Correlation analysis between DNT cells,cytokines,and T cell subsets was conducted,and the predictive value was evaluated by receiver operating characteristic(ROC)curve.Results The levels of DNT cells,IL⁃1β,IL⁃5,IL⁃6,IFN⁃γ,and TNF⁃αin patients with focal epilepsy were significantly higher than those in the control group,the differences were statistically significant(Z=-6.15,-3.20,-3.09,-3.20,-2.41,-2.44;all P<0.05).However,there was no significant difference in the levels of IL⁃2,IL⁃4,IL⁃8,IL⁃10,IL⁃12p70,IL⁃17,IFN⁃α,CD4^(+)T,and CD8^(+)T cells between the two groups(all P>0.05).DNT cells showed a positive correlation with IL⁃17 and TNF⁃α(r=0.221,0.258;all P<0.05)while exhibiting a negative correlation with CD4^(+)T cells(r=-0.332,P<0.05),but no significant correlation was found with other indicators(P>0.05).ROC curve analysis showed that the area under the curve of DNT,TNF⁃α,IL⁃1β,IL⁃5,IL⁃6,IFN⁃γlevels and combined detection for diagnosing focal epilepsy were 0.816,0.785,0.674,0.668,0.674,0.631 and 0.858,respectively.The corresponding sensitivities were 64.04%,77.53%,64.04%,69.66%,48.31%,68.54%and 67.42%,respectively,and the corresponding specificities were 92.31%,69.05%,71.43%,57.14%,83.33%,57.14%and 95.24%,respectively.Conclusion The level of DNT cells in peripheral blood was significantly increased in patients with focal epilepsy and was correlated with IL⁃17,TNF⁃α,and CD4^(+)T cells,suggesting their potential role in the pathogenesis of focal epilepsy.