卒中患者T淋巴细胞亚型的变化与卒中后感染的关系  

Relation between changes of T lymphocyte subsets and post-stroke infection in patients with stroke

作　　者：陈泉[1] 王丽君[1] 郭建一[1] 程谦涛[1] 

机构地区：[1]南京医科大学附属淮安一院神经内科,淮安223000

出　　处：《中华神经医学杂志》2010年第9期944-947,共4页Chinese Journal of Neuromedicine

摘　　要：目的 观测卒中患者外周血T细胞亚型的改变,探讨卒中后感染发生的危险因素.方法取卒中患者（n=37）入院时、入院后第1、7和14天以及对照组（同期体检的健康患者20例）的外周血,流式细胞仪检测外周血CD3＋、CD4＋、CD8＋及CD4＋/CD8＋变化,将符合标准的卒中患者纳入感染组和未感染组,Logistic回归分析卒中后发生感染的易感因素.结果 卒中患者CD3＋、CD4＋和CD8＋T细胞百分比较对照组明显下降,差异均有统计学意义（P＜0.05）.在卒中后出现感染的患者（n=12）,在入院后的第1、7、14天外周血CD3＋、CD4＋和CD8＋T细胞百分比逐步上升,但在整个观察期内仍明显低于对照组,差异均有统计学意义（P＜0.05）;卒中后未发生感染的患者（n=12）,CD4＋T细胞百分比在入院后第1天起与对照组比较,差异均无统计学意义（P＞0.05）.Logistic回归分析结果显示卒中入院时CD4＋、CD8＋T细胞百分比,入院第1天CD3＋、CD4＋T细胞百分比,入院第7天CD3＋、CD4＋、CD8＋T细胞百分比以及入院第14天CD3＋T细胞百分比与卒中后发生感染密切相关.结论 卒中患者存在外周血T细胞亚型的变化和免疫功能的降低,T细胞亚型的变化可能对卒中后感染的发生有一定的影响.Objective To study the changes of T lymphocyte subsets in the peripheral blood of patients with stroke to explore the risk factors of post-stroke infection. Methods A total of 37 patients with stroke and 20 age-matched controls were included in the study and blood was obtained from the controls and patients immediately at the admission and 1, 7 and 14 d after the admission. Fluorescein isothiocyanate was used to label the leukocyte subsets （CD3, CD4, CD8）; the changes of CD3＋, CD4＋,CD8＋ and CD4＋/CD8＋ were detected by flow cytometry. Patients met the infection standards were divided into infection group （n=12） and non-infection group （n=12）; and logistic regression analysis was performed to determine the risk factors of post-stroke infection, accordingly. Results Stroke induced a dramatic and immediate loss of T-lymphocytes, mostly pronounced with the percentages of CD3＋, CD4＋and CD8＋ T cells （P〈0.05）. The percentages of CD3＋, CD4＋ and CD8＋ T cells of infected patients were gradually increased on 1, 7 and 14 d after the admission; compared with those of controls, their percentages were still significantly lower throughout the observation period （P〈0.05）. No significant differences on the percentage of CD4＋ T cells were noted between the non-infected patients and the controls since the 1st admission day （P〉0.05）. Logistic multivariate analysis indicated that the percentages of CD4＋ and CD8＋ T cells on admission, CD3＋ and CD4＋ T cells on the 1st d of admission, CD3＋, CD4＋and CD8＋ T cells on the 7th d of admission, CD3＋ T cells on the 14th d of admission were closely related to the post-stroke infection. Conclusion Stroke induces significant changes of T lymphocyte subsets in the peripheral blood and immunosuppression in humans; the alteration of T lymphocyte subsets may influence the development of post- stroke infection.

关 键 词：卒中 感染 T淋巴细胞 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]