高血压脑出血患者阴阳类证分型细胞因子变化规律研究  

Changes of Cytokines in Yin-Yang Syndrome Classification in Hypertensive Cerebral Hemorrhage Patients

作　　者：赵海宁 郑雁文 罗杰莲 崔菀真 郭建文[1] ZHAO Hai-ning;ZHENG Yan-wen;LUO Jie-lian;CUI Wan-zhen;GUO Jian-wen(Second Clinical College,Guangzhou University of Chinese Medicine,Guangzhou,510120;Department of Emergency,Longhua Hospital,Shanghai University of Chinese Medicine,Shanghai,200323)

机构地区：[1]广州中医药大学第二临床医学院,广州510120 [2]上海中医药大学附属龙华医院急诊科,上海200323

出　　处：《中国中西医结合杂志》2024年第7期792-798,共7页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：国家中医临床研究基地业务建设科研专项课题(No.JDZX2015048);广东省科技厅重点研发计划(No.2020B1111100009);广东省中医院中医药科学技术研究专项课题(No.YN2018ML06)。

摘　　要：目的 探讨细胞因子在高血压脑出血(ICH)及卒中相关肺炎(SAP)患者血清细胞因子变化规律。方法 共纳入ICH患者60例,根据证型分为阴类证组19例(伴SAP 6例,不伴SAP 13例)及阳类证组41例(伴SAP 37例,不伴SAP 4例)。进行患者病情评分比较;采用液体芯片和ELISA检测ICH发病后0~3(T1)、4~7(T2)、8~14(T3)、15~25天(T4)四个时点炎性细胞因子的血清浓度。结果 与阴类证组比较,阳类证组入院时美国国立卫生研究院卒中量表(NIHSS)、肺炎严重程度评分系统(PSI)、脑出血临床分级评分(ICH-S)、出院时改良Rankin量表(mRS)评分升高(P<0.05,P<0.01),入院时格拉斯哥昏迷量表(GCS)评分降低(P<0.01)。ICH患者中至少有一个时点两组差异有统计学意义的细胞因子有:白细胞介素(IL)-88、IL-1受体拮抗剂(IL-1RA)、巨噬细胞炎症因子1(MIP-1)β、IL-18、IL-5、趋化因子干扰素诱导蛋白10(IP-10)、IL-7、IL-12p70、单核细胞趋化蛋白-1(MCP-1)、IL-1α、IL-22、基质细胞衍生因子-1(SDF-1)α(P<0.05)。阳类证患者在T1、T2大量促炎性细胞因子浓度升高,包括MIP-1α、MIP-β、IL-18、IL-17A、IL-31;早期升高的抗炎细胞因子包括IL-10、IL-4、IL-8;上述细胞因子在阴类证组的T1时点则水平降低。调节激活正常T-细胞表达分泌因子(RANTES)的血清浓度不论是否合并SAP,在阴阳类证中均表现为T1升高,T2时点降低,最终T4低于基线状态的浓度。ICH合并SAP患者中至少有一个时点两组之间差异有统计学意义的细胞因子有:IP-10、IL-1RA、MIP-1β、IL-18(P<0.05)。ICH合并SAP阳类证患者促炎细胞因子在T1、T2浓度升高,包括:IP-10、MCP-1、IL-8、IL-17A、MIP-1α、MIP-1β、IL-31、干扰素γ(IFN-γ)、IL-1α、IL-21、IL-22。结论 ICH患者血清细胞因子在阴阳类证分型下呈现动态变化规律,促炎反应是阳类证的基础。Objective To investigate the patterns of serum cytokine changes in patients with hypertensive intracerebral hemorrhage(ICH)and stroke-associated pneumonia(SAP).Methods A total of 60 ICH patients were enrolled and assigned to two groups based on Chinese medicine(CM)syndromes:the Yin syndrome group(19 cases,including 6 with SAP and 13 without SAP)and the yang syndrome group(41 cases,including 37 with SAP and 4 without SAP).Patient condition scores were compared.Serum concentrations of inflammatory cytokines at four time points post-ICH onset[0-3(T1),4-7(T2),8-14(T3),and 15-25 days(T4)]were measured using liquid chip technology and ELISA.Results Compared with the yin syndrome group,the yang syndrome group showed higher scores on the National Institutes of Health Stroke Scale(NIHSS),Pneumonia Severity Index(PSI),Intracranial Haemorrhage Score(ICH-S)at admission,and modified Rankin Scale(mRS)at discharge(P<0.05,P<0.01),and lower Glasgow Coma Scale(GCS)scores at admission(P<0.01).Cytokines that showed statistically significant differences between the two groups at least one time point included interleukin(IL)-88,recombinant IL-1 receptor acntagonist(IL-1RA),macrophage inflammatory protein-1(MIP-1)β,IL-18,IL-5,interferon-inducible protein-10(IP-10),IL-7,IL-12p70,monocyte chemotactic protein 1(MCP-1),IL-1α,IL-22,and stromal cell derived factor 1(SDF-1)α(P<0.05).In the yang syndrome group,the concentrations of several pro-inflammatory cytokines,including MIP-1α,MIP-1β,IL-18,IL-17A,and IL-31,increased significantly at T1 and T2.Early increases were observed in some anti-inflammatory cytokines,including IL-10,IL-4,and IL-8.In contrast,these cytokines decreased at T1 in the yin syndrome group.The serum concentration of regulated on activation,normal T cell expressed and secreted(RANTES)increased at T1,decreased at T2,and ultimately fell below baseline levels at T4 in both groups,regardless of SAP presence.In ICH patients with SAP,cytokines showing statistically significant differences between the two groups at least one

关 键 词：高血压性脑出血 卒中相关肺炎 血清细胞因子 阴阳类证 中西医结合 

分 类 号：R277.7[医药卫生—中医学]