文章摘要
刘洁，胡小辉，龚道恺.急性缺血性卒中早期外周血Th17/Treg失衡情况及与预后的关系[J].神经损伤功能重建,2020,15(4):190-193
急性缺血性卒中早期外周血Th17/Treg失衡情况及与预后的关系
Imbalance of Th17/Treg in Peripheral Blood of Acute Ischemic Stroke Patients and Its Rela⁃tionship with Prognosis
  
DOI：
中文关键词: 急性缺血性卒中  辅助性T细胞17  调节性T细胞  Th17/Treg  预后
英文关键词: acute ischemic stroke  helper T cells 17  regulatory T cells  Th17/Treg  prognosis
基金项目:荆州市科技发展计 划项目（No. 20170 31）
作者单位
刘洁，胡小辉，龚道恺 长江大学第二临床 医学院神经内科 
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中文摘要:
      目的：探讨急性缺血性卒中（AIS）早期外周血辅助性T细胞17（Th17）和调节性T细胞（Treg）比值及 其与发病90 d预后的关系。方法：AIS患者64例纳入AIS组，健康体检者40例纳入对照组。采用流式细胞 仪测定并比较外周血Th17、Treg细胞水平和Th17/Treg比值。根据 90 d后改良Rankin量表（mRS）评分，将 患者分为预后良好37例及预后不良组27例。比较不同预后组患者的临床资料；Spearman分析Th17/Treg与 病情严重程度的相关性；多因素Logistics回归分析AIS患者90 d预后不良发生的影响因素；受试者工作特 征曲线评价入院时Th17/Treg水平对AIS患者进行预后的评估效率。结果：AIS组外周血Th17比例增高， Treg比例降低，Th17/Treg明显高于对照组（均P＜0.05）。预后不良组入院时外周血Th17/Treg、白细胞介素 （interleukin，IL）-6水平、梗死灶体积和NIHSS评分均高于预后良好组（均P＜0.01）。IL-6、NIHSS及梗死体 积与Th17/Treg正相关（P＜0.001）。梗死灶体积和Th17/Treg是AIS患者90 d预后不良发生的独立影响因素 （P＜0.05）。Th17/Treg 预测 AIS 患者预后的 ROC 曲线下面积为 0.898（95%CI: 0.828～0.971，P=0.000）。 Th17/Treg最有效的截断值为3.775，此时预测敏感性为66.7%，特异性为97.3%。结论：AIS患者早期外周外 周血Th17/Treg增加，并对不良预后有一定的预测价值。
英文摘要:
      To investigate the early-stage Th17/Treg ratio in the peripheral blood of acute ischemic stroke (AIS) patients and its relationship with 90-day prognosis. Methods: We assigned 64 patients with AIS and 40 healthy controls to the AIS group and control group, respectively. The levels of Th17 and Treg cells and the ratio of Th17/Treg in the peripheral blood of all participants were detected by flow cytometry. Patients were divided into the good prognosis group (n=37) and poor prognosis group (n=27) according to the mRS score after 90 days. The clinical data of the two groups were compared. Spearman analysis was used to assess the relationship between Th17/Treg and severity of condition. Multivariate logistic regression analysis was used to examine the influencing factors of a poor 90-day prognosis. The receiver operating characteristic curve (ROC) was used to evaluate the predictive effect of the Th17/Treg ratio at time of admission. Results: The peripheral blood Th17 level was increased, Treg level decreased, and Th17/Treg ratio significantly increased in AIS group patients compared to control group patients (all P<0.05). The poor prognosis group showed significantly higher peripheral blood Th17/Treg, IL-6 level, infarct volume, and NIHSS score compared to the good prognosis group (all P< 0.01). IL-6, NIHSS, and infarct volume were positively correlated with Th17/Treg (P<0.001). Infarct volume and Th17/Treg were independent risk factors for a poor 90-day prognosis. The area under the ROC curve for Th17/ Treg in predicting AIS prognosis was 0.898 (95%CI: 0.828～0.971, P=0.000). The optimal cutoff value of Th17/ Treg was 3.775 with a sensitivity of 66.7% and a specificity of 97.3%. Conclusion: The early-stage Th17/Treg ratio in peripheral blood increased in patients with AIS and offered a certain predictive value for 90-day poor prognosis.
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