Correlation between the levels of immune and inflammatory factors and nerve injury after acute ischemic stroke
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摘要: 目的 观察免疫及炎性因子变化对急性缺血性卒中(AIS)病情评估的作用。方法 回顾性选取2020年8月－2021年6月期间我院神经内科收入院的240例AIS患者(AIS组)，依据NIHSS评分分为轻、中、重度组; 另选取同期在我院体检中心体检并确认伴有至少一种脑血管病危险因素的100例体检者为对照组。所有AIS亚组患者均按照中国急性缺血性脑卒中诊治指南给予抗血小板聚集、降脂等对症支持治疗，收集AIS各亚组患者入院后24 h内的外周血样本，采用流式细胞术测定CD4+CD25+及CD4+CD28-含量，使用Elisa试剂盒测定血清IL-6、IL-10、TGF-β1含量。对比各组受试者上述指标的差异。对照组留取一次血样，检测上述指标，进行对照分析。结果 AIS组患者外周血中CD4+CD25+细胞含量低于对照组，CD4+CD28-细胞含量高于对照组(P< 0.05);AIS组患者血清中IL-6水平高于对照组，IL-10、TGF-β1水平低于对照组(P< 0.05)。AIS组各亚组间外周血中CD4+CD25+、CD4+CD28-细胞含量对比均具有统计学差异(P< 0.05)。AIS重度组患者外周血中CD4+CD25+细胞含量低于轻、中度组，CD4+CD28-细胞含量高于轻、中度组(P< 0.05);AIS中度组患者外周血中CD4+CD25+细胞含量低于轻度组，CD4+CD28-细胞含量高于轻度组(P< 0.05)。AIS各亚组间血清炎性因子水平对比具有统计学差异(P< 0.05)。AIS重度组患者血清IL-6水平高于轻、中度组，血清IL-10、TGF-β1水平低于轻、中度组(P< 0.05);AIS中度组患者血清IL-6水平高于轻度组，血清IL-10、TGF-β1水平低于轻度组(P< 0.05)。结论 AIS患者血中IL-6、CD4+CD28-均呈高表达，IL-10、TGF-β1、CD4+CD25+呈低表达，与神经功能受损程度存在一定相关性，临床可用于评估AIS患者病情。Abstract: Objective To investigate the effects of immune and inflammatory factors on the evaluation of acute ischemic stroke(AIS).Methods A total of 240 AIS patients(AIS group) hospitalized in the department of Neurology of our hospital from August 2020 to June 2021 were retrospectively selected and divided into mild, moderate and severe groups according to NIHSS score. 100 patients who underwent physical examination in the physical examination center of our hospital during the same period and confirmed with at least one risk factor of cerebrovascular disease were selected as the control group. All patients in THE AIS subgroup were given antiplatelet aggregation, lipid-lowering and other supportive treatments according to the Chinese Guidelines for the diagnosis and treatment of acute ischemic stroke. Peripheral blood samples of patients in the AIS subgroup were collected within 24 hours after admission, and the content of CD4+ CD25+ and CD4+CD28-cells were determined by flow cytometry. Serum IL-6, IL-10 and TGF-β1 were determined by Elisa kit. The differences of the above indicators were compared among each group. A blood sample was taken from the control group to detect the above indicators for comparative analysis.Results The content of CD4+CD25+ cells in peripheral blood of AIS group was lower than that of control group, and the content of CD4+CD28-cells was higher than that of control group(P< 0.05). The serum LEVELS of IL-6 in AIS group were higher than those in control group, while the levels of IL-10 and TGF-β1 were lower than those in control group(P< 0.05). There were statistically significant differences in CD4+CD25+ and CD4+CD28-cells in peripheral blood of AIS group(P< 0.05). The content of CD4+CD25+ cells in peripheral blood of patients in severe AIS group was lower than that in mild and moderate AIS groups, and the content of CD4+CD28-cells was higher than that in mild and moderate AIS groups(P< 0.05). The content of CD4+CD25+ cells in peripheral blood of patients in moderate AIS group was lower than that in mild AIS group, and the content of CD4+CD28-cells was higher than that in mild AIS group(P< 0.05). There were statistically significant differences in serum inflammatory factors between AIS subgroups(P< 0.05). Serum IL-6 levels in severe AIS group were higher than those in mild and moderate AIS groups, while serum IL-10 and TGF-β1 levels were lower than those in mild and moderate AIS groups(P< 0.05). The serum IL-6 level in moderate AIS group was higher than that in mild AIS group, and the serum IL-10 and TGF-β1 levels were lower than that in mild AIS group(P< 0.05).Conclusion The high levels of IL-6 and CD4+CD28-cells as well as the low levels of IL-10, TGF-β1 and CD4+CD25+ in the blood of AIS patients are correlated with the degree of neurological impairment, which can be used to evaluate the condition of AIS patients.
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Key words:
- ischemic stroke /
- inflammatory cytokine /
- nerve injury
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表 1 AIS组与对照组基线资料比较
例(%), X±S 临床资料 AIS组(240例) 对照组(100例) t/χ2 P 年龄/岁 65.8±9.3 64.6±8.2 1.121 0.263 性别 2.859 0.090 男 169(70.4) 61(61.0) 女 71(29.6) 39(39.0) BMI 23.9±2.4 23.8±2.9 0.329 0.743 吸烟史 130(54.2) 48(48.0) 1.076 0.299 基础疾病 高血压 209(87.1) 79(79.0) 3.560 0.059 高脂血症 119(49.6) 54(54.0) 0.550 0.457 糖尿病 51(21.6) 15(15.0) 1.762 0.184 
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表 2 AIS组与对照组间免疫因子水平
%, X±S 组别 例数 CD4+CD25+ CD4+CD28- AIS组 240 30.22±4.02 16.22±2.09 对照组 100 38.45±6.21 10.04±1.23 t 2.896 3.447 P 0.040 0.034
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表 3 AIS组与对照组间炎性因子水平对比
X±S 组别 例数 IL-6/ (pg·mL-1) IL-10/ (ng·mL-1) TGF-β1/ (pg·mL-1) AIS组 240 26.03±3.44 33.92±4.76 50.76±8.44 对照组 100 7.48±1.04 84.98±9.44 89.68±11.44 t 7.734 6.257 4.864 P 0.019 0.024 0.029
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表 4 AIS组各亚组间免疫因子水平
%, X±S 组别 例数 CD4+CD25+ CD4+CD28- 轻度组 80 34.27±5.62 14.45±2.65 中度组 80 30.62±6.101) 17.22±2.341) 重度组 80 26.03±4.551)2) 22.23±1.231)2) F 15.744 25.567 P 0.001 0.001 与轻度组比较，1)P < 0.05;与中度组对比，2)P < 0.05。
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表 5 AIS组与对照组间炎性因子水平对比
X±S 组别 例数 IL-6/ (pg·mL-1) IL-10/ (ng·mL-1) TGF-β1/ (pg·mL-1) 轻度组 80 18.62±4.04 42.89±6.75 65.06±8.87 中度组 80 25.47±3.141) 29.33±3.211) 48.29±7.921) 重度组 80 32.55±3.041)2) 24.18±7.241)2) 38.87±8.561)2) F 9.964 10.654 13.379 P 0.002 0.001 0.001 与轻度组对比，1)P < 0.05;与中度组对比，2)P < 0.05。
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