老年男性心功能不全患者外周血CD_4^+和CD_8^+调节T细胞的变化及免疫调节的干预作用  

Analysis of change in percentage of CD_4^+ and CD_8^+ Treg in peripheral blood in aged male patients with chronic cardiac insufficiency

作　　者：韩丽娜[1] 林晓明[2] 臧传波[1] 李靖[1] 杨立明[1] 丁国雷[1] 彭锦[2] 

机构地区：[1]中国人民解放军总医院海南分院保健科,海南三亚572014 [2]中国人民解放军第187中心医院心内科,海南海口571159

出　　处：《海南医学》2013年第19期2866-2872,共7页Hainan Medical Journal

基　　金：中国人民解放军总医院临床科研扶持基金(编号:2012FC-TSYS-2024);2012年度海南省医学普通科研立项课题(编号:琼卫2012PT-66);海南省社会发展科技专项资金项目(编号:SF201337)

摘　　要：目的探讨T淋巴细胞亚群CD4+调节细胞(CD4+CD25+Treg)和CD8+调节细胞(CD8+CD28-Treg)在老年男性慢性心功能不全患者外周血中的变化,以及免疫调节治疗对其的影响。方法 155例老年男性,114例诊断为慢性心功能不全(CCI),41例为心功能正常者。所有患者均行超声心动图检测,并采集外周血。分离外周血T淋巴细胞,采用流式细胞学检测技术测定CD4+CD25+Treg和CD8+CD28-Treg亚群分布。非均相免疫法检测血浆N末端脑利钠肽前体(NT-proBNP)水平,免疫比浊法检测C反应蛋白(CRP)。参与者分成三组,第一组是正常对照组(n=41),第二组是CCI干预组(n=60),接受常规抗心功能不全和胸腺五肽治疗(20 mg,肌肉注射,隔日1次,共3个月),第三组是CCI对照组(n=54),只给予常规抗心功能不全治疗。结果与对照组相比,CCI两组左室射血分数(LVEF)、CD4+CD25+Treg和CD8+CD28-Treg亚群水平下降;而左室舒张末期内径(LVEDD)、NT-proBNP和CRP水平升高。NT-proBNP和CRP水平同LVEF呈负相关,CD4+CD25+Treg和CD8+CD28-Treg水平同LVEF呈正相关。而CCI干预组较CCI对照组能更好地升高CD4+CD25+Treg和CD8+CD28-reg亚群水平而改善心功能。结论 CD4+CD25+Treg和CD8+CD28-Treg水平变化提示其在CCI过程中发挥重要作用,CD4+和CD8+调节T细胞变化可能是治疗CCI的重要方向之一。Objective To investigate the change in percentage ofCD4＋CD25＋ Treg and CD,＋CD2s- Treg in pe- ripheral blood in aged male patients with chronic cardiac insufficiency （CCI）. Methods The participants were 155 el- derly men, among whom 114 were diagnosed as CCI and 41 had normal heart function. All patients underwent echo- cardiography examination and had their peripheral blood collected. T lymphocytcs in peripheral blood were separated and determined distribution of CD,＋CD2s＋ Treg and CD~＋CD2s- Treg using flow cytometry. Scram N terminal pro-brain nahiuretic pepride （NT-proBNP） levels were detected by heterogeneous imrnunoassay. C reactive protein （CRP） was detected by immunoturbidimctry assay. Participants wcrc divided into three groups： the CCI intccntion group （re- ceived regular therapy and thymopcndin, 20 mg intramuscular injection, once every other day for 3 months, n=60）, the CCI control group （received regular therapy, n=54）, and the control group （a=41）. Results In comparison to the con- trol group, levels of IcR vcntricular ejection fraction （LVEF）, CD,＋CD5＋ Treg and CD8CD28- Trcg decreased in CCI in- tervention group and CCI control group, while levels of leR ventricular end diastolic diameter （LVEDD）, NT-proBNP and CRP increased. Levels of NT-proBNP and CRP wcrc negatively correlated with LVEF, while levels of CD4＋CD2s＋ Trcg and CDs^CD^- Trcg showed positive correlation with LVEF. LVEF could be much improved via increasing distri- bution of CD4＋CD25＋ Treg and CD~＋CD2a- Trcg in CCI intervention group than in CCI control group. Conclusion The abnormal distribution of CD4＋CD25＋ Trcg and CD8＋CD28- Trcg suggcstcs that they play an important role in the develop- ment of CCI. Modulation of these T lymphocytcs subsets might bca strategy to treat CCI.

关 键 词：慢性心功能不全 免疫 老年 CD4+CD25+TREG CD8+CD28-Treg 

分 类 号：R541[医药卫生—心血管疾病]