急性缺血性脑卒中患者脑梗死面积与细胞因子和免疫状态的关联性分析  

Analysis on correlation of cerebral infarct area with cytokines and immune status in patients with acute ischemic stroke

作　　者：苏醒麒 赵灵敏 马迪[1] 尤久琳 陈盈[1] 冯良枢 王晶[1] 冯加纯[1] 王川[1] SU Xingqi;ZHAO Lingmin;MA Di;YOU Jiulin;CHEN Ying;FENG Liangshu;WANG Jing;FENG Jiachun;WANG Chuan(Department of Neurology,First Hospital,Jilin University,Changchun,130021,China)

机构地区：[1]吉林大学第一医院神经内科,吉林长春130021

出　　处：《吉林大学学报(医学版)》2025年第1期124-132,共9页Journal of Jilin University:Medicine Edition

基　　金：国家自然科学基金项目(82071289);吉林省科技厅自然科学基金项目(YDZJ202201ZYTS037)。

摘　　要：目的:探讨急性缺血性脑卒中患者的脑梗死面积与细胞因子和免疫状态的关联性,为不同程度脑梗死患者的免疫治疗提供理论依据。方法:根据纳入标准和排除标准选取发病72 h内的67例急性缺血性脑卒中患者作为研究对象,根据磁共振弥散加权成像(DWI)序列的最大梗死层面面积将患者分为大面积脑梗死组(n=34)和非大面积脑梗死组(n=33)。收集2组患者的性别、年龄和既往病史等临床基线资料,采用流式细胞术检测2组患者血清中白细胞介素(IL)-2、IL-6、IL-10、IL-17A、肿瘤坏死因子α(TNF-α)和干扰素γ(IFN-γ)水平,计算2组患者外周血中淋巴细胞绝对值(LYM#)、淋巴细胞百分比(LYM%)和中性粒细胞/淋巴细胞比值(NLR),同时计算IFN-γ/IL-4比值、TNF-α/IL-4比值和TNF-α/IL-10比值;并依据临床神经专科查体体征评价2组患者美国国立卫生研究院卒中量表(NIHSS)评分;采用秩相关分析检验2组患者脑梗死面积与NIHSS评分、细胞因子和免疫状态之间的相关性。结果:与非大面积脑梗死组比较,大面积脑梗死组患者血清中IL-2、IL-6、IL-10、IL-17A、TNF-α和IFN-γ水平以及外周血中NLR均明显升高(P<0.01),LYM#、LYM%和TNF-α/IL-4比值明显降低(P<0.01)。秩相关分析,大面积脑梗死组患者脑梗死面积与患者NIHSS评分呈正相关关系(r_(s)=0.521,P<0.05),非大面积脑梗死组患者脑梗死面积与患者NIHSS评分呈明显正相关关系(r_(s)=0.721,P<0.001)。2组患者的NIHSS评分与血清中IL-6(r_(s)=0.306,P=0.005)、IL-4(r_(s)=0.252,P<0.001)、IL-2(r_(s)=0.109,P=0.025)、IL-17A(r_(s)=0.405,P<0.001)和IFN-γ(r_(s)=0.146,P<0.001)水平均呈正相关关系;NIHSS评分与TNF-α(r_(s)=0.039,P=0.726)和IL-10(r_(s)=0.121,P=0.192)水平无相关性。2组患者的NIHSS评分与血清中LYM#(r_(s)=-0.026,P=0.036)和LYM%(r_(s)=-0.008,P=0.002)呈负相关关系,与NLR呈正相关关系(r_(s)=0.315,P=0.009)。结论:急性脑梗死患者的梗死面积与NIHSS评�Objective:To explore the correlations between the cerebral infarction area and cytokines and immune status in patients with acute ischemic stroke,and to provide the theoretical basis for immunotherapy of the patients with different degrees of cerebral infarction.Methods:Sixty-seven patients with acute ischemic stroke within 72 h of the onset were randomly selected according to the inclusion and exclusion criteria,and were divided into large-area cerebral infarction group(n=34)and non-large-area cerebral infarction group(n=33)on the basis of the biggest infarction area in the sequences of magnetic resonance diffusion-weighted imaging(CDWI).Clinical baseline characteristics such as gender,age,and medical history were collected from the patients in two groups,the serum levels of interleukin(IL)-2,IL-6,IL-10,and IL-17A,tumor necrosis factor-α(TNF-α),and interferon-γ(IFN-γ)were measured using flow cytometry;the absolute values of lymphocytes(LYM#),lymphocyte percentages(LYM%),and neutrophil/lymphocy ratios(NLR)in peripheral blood of the patients caiculated,and the ratios of IFN-γ/IL-4,TNF-α/IL-4,and TNF-α/IL-10 rations were also calculated.The values of National Institutes of Health Stroke Scale(NIHSS)scores of the patients were evaluatd on the basis of the assessment of clinical neurological signs.The correlations of the cerebral infarction area and NIHSS score,cytokines and immune status groups of the patients in two were tested by rank correlation analysis.Results:Compared with non-large-area cerebral infarction group,the serum levels of IL-2,IL-6,IL-10,IL-17A,TNF-α,and IFN-γas well as the NLR in the peripheral blood of the patients in large-area cerebral infarction group were significantly increased(P<0.01),while the LYM#,LYM%and TNF-α/IL-4 were significantly decreased(P<0.01).There was a positive correlation between cerebral infarction area and NIHSS score in the patients in large-area cerebral infarction group(r_(s)=0.521,P<0.05),and there was a significantly positive correlation between cerebral infar

关 键 词：急性脑梗死 免疫 炎症 细胞因子 炎性细胞 梗死面积 美国国立卫生研究院卒中量表评分 

分 类 号：R781.42[医药卫生—口腔医学]