急性重症脑卒中患者单核细胞免疫抑制与炎性标志物的相关性  

Correlations between monocyte immunosuppression and the inflammatory markers in patients with severe acute stroke

作　　者：张道培[1] 闫福岭[1] 朱奕昕[1] 徐海清[1] 袁宝玉[1] 尹琰[2] 卢航青[2] 

机构地区：[1]东南大学附属中大医院神经内科,南京210009 [2]东南大学医学实验中心细胞分析室

出　　处：《中华神经医学杂志》2008年第10期1067-1070,共4页Chinese Journal of Neuromedicine

摘　　要：目的探讨急性重症脑卒中患者单核细胞免疫抑制与C-反应蛋白（CRP）和纤维蛋白原（Fg）的关系，了解卒中患者免疫抑制的可能机制。方法研究连续入选的24h内入住神经重症监护病房（NICU）的急性脑卒中患者（53例），以同期神经内科普通病房住院的头晕患者（均经头颅MRI排除急性脑卒中）作为对照组（39例）。检测脑卒中患者入院后第1、2、4、6和14天的单核细胞人类白细胞抗原-DR（HLA-DR）表达水平和卒中组、对照组人院后第2天CRP和Fg的浓度。采用GraphPad PRISM4．0 demo软件进行因素之间的关联分析。结果与对照组比较，卒中组CRP、融的水平增高，差异有统计学意义（P〈0．05）。卒中组CRP和Fg与不同时间点的单核细胞HLA—DR表达水平有不同程度的负相关性。CRP与入院后第2天HLA-DR表达负相关性最明显（r=-0．419，P=0．001）。Fg与入院后第4天HLA-DR表达负相关性最明显（r=-0．434，P=0．001）。结论急性重症脑卒中患者单核细胞免疫抑制机制与卒中后炎症反应有关。Objective To explore the correlations between monocyte immunodepression and the levels of C-reactive protein （CRP） and fibrinogen （Fg） in patients with severe acute stroke. Methods This prospective study involved 53 consecutive patients admitted in the neurological intensive care unit （NICU） within 24 h after stroke onset. Blood samples were collected serially on days 1, 2, 4, 6 and 14 after stroke to determine monocytic HLA-DR expression using flow cytometry. CRP and Fg were detected on day 2 after the admission, and GraphPad PRISM 4.0 software was used to analyze the correlations among the variables. Thirty-nine concurrent patients admitted in the general ward, who complained dizziness without magnetic resonance imaging evidence of acute stroke, were enrolled to serve as the control group. Results The levels of CRP and Fg in the stroke group were significantly higher than those in the control group （P〈0.05）. The CRP and Fg levels were both found to inversely correlate to monocytic HLA-DR expression at different observational points. The correlations of CRP and Fg to HLA-DR expression were the most obvious on day 2 and 4 after admission （r=-0.419, P=-0.001; r=-0.434,P=0.001）, respectively. Conclusion Immunosuppression of the monocytes in patients with severe acute stroke is probably associated with the inflammatory reaction after stroke.

关 键 词：急性脑卒中 人类白细胞抗原-DR C-反应蛋白 纤维蛋白原 

分 类 号：R743.33[医药卫生—神经病学与精神病学]