血清25-羟基维生素D、Th17/Treg细胞失衡与新生儿缺氧缺血性脑病预后的相关性研究  

Relationship between Serum 25-hydroxy Vitamin D,Th17/Treg Cell Imbalance and Prognosis of Neonatal Hypoxic Ischemic Encephalopathy

作　　者：屈菊梅 张龙[1] 刘荣[1] QU Ju-mei;ZHANG Long;LIU Rong(Department of Neonatology,Yan'an People's Hospital,Yan'an 716000,China)

机构地区：[1]陕西省延安市人民医院新生儿科,延安716000

出　　处：《微循环学杂志》2023年第3期65-70,共6页Chinese Journal of Microcirculation

摘　　要：目的:探究缺氧缺血性脑病(HIE)患儿血清25-羟基维生素D[25(OH)D]及Th17/Treg细胞水平的变化及其与患儿预后的关系。方法:选取2019-01-2021-01本院收治的79例HIE患儿(HIE组),根据临床分度分为中度组(46例)和重度组(33例);根据HIE组患儿神经发育随访情况将其分为神经发育正常组(52例)和不良神经发育组(27例)。选取同时期本院健康新生儿79例为对照组。利用流式细胞术检测外周血中Treg细胞比率、Th17细胞比率并计算Th1/Th17细胞比率;采用酶联免疫吸附(ELISA)法检测血清中25(OH)D、白细胞介素(IL)-17、IL-23及IL-10和转化生长因子-β(TGF-β)水平。Cox风险比例回归模型评估HIE患儿预后不良的影响因素;采用Pearson法分析Th17/Treg与25(OH)D之间的相关性。结果:与对照组相比,HIE组血清中IL-17、IL-23水平、Th17细胞比率及Th17/Treg细胞比率较高(P<0.05),25(OH)D、IL-10、TGF-β水平、Treg细胞比率较低(P<0.05);与中度组相比,重度组血清中IL-17、IL-23水平、Th17细胞比率及Th17/Treg细胞比率较高(P<0.05),25(OH)D、IL-10、TGF-β水平、Treg细胞比率较低(P<0.05);与中度组相比,重度组入院时、治疗14天后的NBNA评分较低(P<0.05)。与神经发育正常组相比,不良神经发育组入院时、治疗14天后的NBNA评分较低(P<0.05);血清中IL-17、IL-23水平、Th17细胞比率及Th17/Treg细胞比率较高(P<0.05),25(OH)D、IL-10、TGF-β水平、Treg细胞比率较低(P<0.05)。多因素Cox分析显示,低水平25(OH)D、Th17/Treg细胞失衡是影响HIE患儿不良预后的危险因素(P<0.05)。HIE患儿Th17/Treg与25(OH)D负相关(r=-0.680,P<0.05)。结论:HIE患儿血清25(OH)D呈低表达,外周血单个核细胞Th17/Treg细胞比率存在免疫失衡,25(OH)D缺乏和Th17/Treg细胞失衡可能与HIE预后不良有关。Objective:To explore the changes in serum levels of 25 hydroxyvitamin D[25(OH)D]and Th17/Treg cells in children with hypoxic ischemic encephalopathy(HIE),and the relationship between 25(OH)D and Th17/Treg cells and the prognosis of children.Method:79 children with HIE admitted to our hospital from January 2019 to January 2021 were selected as the study subjects(HIE group).According to clinical grading,they were divided into a moderate group of 46 cases and a severe group of 33 cases.According to the neurodevelopmental status of HIE patients followed up,they were divided into a normal neurodevelopmental group of 52 cases and a poor neurodevelopmental group of 27 cases.79 cases of healthy newborns in our hospital at the same time were selected as the control group.The ratios of Treg cells and Th17 cells in peripheral blood were detected by flow cytometry,and the ratio of Th1/Th17 cells was calculated.The levels of 25(OH)D,interleukin(IL)-17,IL-23,IL-10 and transforming growth factor-β(TGF-β)in serum were detected by enzyme-linked immunosorbent assay(ELISA).Cox risk proportional regression model was used to evaluate the influencing factors of poor prognosis in HIE children.The correlation between Th17/Treg and 25(OH)D was analyzed by Pearson's method.Results:Compared with those in the control group,the levels of IL-17 and IL-23 in serum,the ratio of Th17 cells and the ratio of Th17/Treg cells in HIE group were higher(P<0.05),while the levels of 25(OH)D,IL-10,TGF-βin serum and the ratio of Treg cells were lower(P<0.05).Compared with those in the moderate group,the levels of IL-17 and IL-23 in serum,the ratio of Th17 cells and the ratio of Th17/Treg cells in the severe group were lower(P<0.05),while the levels of 25(OH)D,IL-10,TGF-βin serum and the ratio of Treg cells were higher(P<0.05).Compared with the moderate group,the NBNA score of the severe HIE group at admission and 14 days after treatment was lower(P<0.05).Compared with the normal neurodevelopment group,the poor neurodevelopment group had lower NBNA scor

关 键 词：新生儿缺氧缺血性脑病 25-羟基维生素D TH17/TREG细胞 

分 类 号：R722.1[医药卫生—儿科]