急性脑梗死患者免疫调节性T淋巴细胞表达与预后的关系  

Immunological Activity Change of Regulatory T Cells and Its Relation with Outcome of Patients with Acute Cerebral Infarction

作　　者：蒋福生[1] 张平[1] 张新华[1] 

机构地区：[1]南华大学附属南华医院神经内科,湖南省衡阳市421002

出　　处：《中国动脉硬化杂志》2013年第10期923-926,共4页Chinese Journal of Arteriosclerosis

摘　　要：目的探讨急性脑梗死患者外周血免疫调节性T淋巴细胞的表达及其与预后的关系。方法急性脑梗死患者30例,根据多器官功能障碍综合征诊断标准分为多器官功能障碍综合征组(n=8)和非多器官功能障碍综合征组(n=22),根据患者转归分为死亡组(n=5)和生存组(n=25);正常对照组为同期健康体检者30例。分别采集各组的外周静脉血,采用免疫磁性分离系统对外周血CD4+CD25+Treg进行分离纯化;采用流式细胞术检测CD4+CD25+Treg表面分子T淋巴细胞毒性相关抗原4(CTLA-4)的表达;酶联免疫吸附试验(ELISA)检测CD4+CD25+Treg孵育液上清中白细胞介素10(IL-10)的水平。结果急性脑梗死组患者CD4+CD25+Treg表面分子CTLA-4表达率(36.68%±7.41%)及分泌IL-10水平(15.38±3.79 ng/L)与正常对照组(22.20%±7.18%和8.96±3.28 ng/L)比较,均明显升高(P<0.01);多器官功能障碍综合征组患者CTLA-4表达率(42.10%±7.44%)及分泌IL-10水平(28.30±9.48 ng/L)显著高于非多器官功能障碍综合征组(30.26%±5.60%和17.86±6.54 ng/L;P<0.01);死亡组CTLA-4表达率(44.45%±12.34%)及分泌IL-10水平(33.90±10.62 ng/L)显著高于生存组(31.43%±10.12%和16.08±8.67 ng/L;P<0.01)。结论急性脑梗死患者可促进外周血CD4+CD25+Treg表面分子表达,并刺激其分泌大量抑制性细胞因子发挥自身免疫作用,从而导致机体免疫功能障碍甚至免疫紊乱的发生与发展,且与患者的预后密切相关。Aim To investigate the immunological activity change of regulatory T cells （Treg） and discuss its significance in the outcomes of patients with multiple organ dysfunction syndrome （MODS） and acute cerebral infarction（ACI）.Methods According to the development of ACI,patients were divided into MODS group（n8）and non-MODS group（n22）. The patients with ACI were further divided into non-survival group （n5） and survival group（n25）based on their outcomes. Healthy volunteers were served as normal control（n30）. Peripheral blood samples were collected in patients with ACI and healthy volunteers. The immunomagnetic separation technique was applied to separate and purify CD4＋CD25＋Tregs in peripheral blood,and phenotypes（CTLA-4） were analyzed by flow cytometry and the contents of interleukin-10（IL-10） released in the supernatants were determined by ELISA. Results Expression of CTLA-4 and level of IL-10 were significantly increased in patients with ACI compared with normal control group. The expression of CTLA-4 and level of IL-10 in MODS group were much higher than those in non-MODS group （P〈0.01）. Among the ACI patients,the expression of CTLA-4 and level of IL-10 in the survival group were obviously lower than those in the non-survival （P〈0.05 or P〈0.01）. Conclusion After ischemia reperfusion injury of cerebral,expressions of the markers on CD4＋CD25＋Tregs surface and secretion of cytokines produced by CD4＋CD25＋Tregs show significant difference in patients with MODS development and survival state. CD4＋CD25＋Treg may play an important role in the pathogenesis of immunoregulation,MODS and mortality of patients with ACI through secretion of inhibitory cytokines.

关 键 词：急性脑梗死 调节性T淋巴细胞 免疫活性 多器官功能障碍综合征 

分 类 号：R741[医药卫生—神经病学与精神病学]