脑梗死患者的细胞免疫与体液免疫的变化规律研究

doi:10.3877/cma.j.issn.2095-1221.2018.06.004

目的

探讨脑梗死患者的细胞免疫功能与体液免疫功能的变化规律。

方法

2016年5月~ 2017年5月期间广东省佛山市禅城区中心医院收治的脑梗死患者120例设为观察组，观察组患者按照脑梗死的面积分为轻症组（大脑中动脉区域脑梗，脑梗范围的直径≤5 cm者，60例）和中重症组（大脑中动脉区域脑梗，脑梗范围的直径> 5 cm者，60例）；选择120例健康体检者设为对照组。采用流式细胞仪和速率散射免疫透射比浊法测定各组血免疫球蛋白IgA、IgM、IgG、补体C3、C4水平来反应体液免疫功能；用试剂盒、外周血中T淋巴细胞亚群CD3⁺、CD4⁺、CD8⁺、NK细胞、B细胞和CD4⁺/CD8⁺百分率水平的测定；对抗心磷脂抗体（ACA）浓度进行测定；通过ACA浓度反映的颈动脉粥样硬化（CAS）中生化指标的变化分析脑梗死患者的细胞免疫功能与体液免疫功能的关联。多组间比较采用单因素方差分析；患者性别比例采用χ²分析；通过直线相关分析细胞免疫与体液免疫的相关性。

结果

脑梗死中重症组T淋巴细胞含量低于脑梗死轻症组和对照组，差异具有统计学意义（P < 0.05），CD8⁺细胞百分率（27.91%±2.97%）T淋巴细胞含量高于脑梗死轻症组和对照组，CD4⁺/CD8⁺比值（1.98±0.03）水平高于脑梗死轻症组和对照组（P < 0.05）；与脑梗死轻症组和对照组比较，脑梗死中重症组NK细胞（12.29%±1.58%）和B细胞（12.76%±2.00%）均下降（P < 0.05）。与脑梗死轻症组和对照组比较，脑梗死中重症组血清中血球免疫球蛋白IgG（10.60±1.06）IU/ml水平降低（P < 0.05）；血球免疫球蛋白IgA（4.01±0.35）IU/ml、补体C3（2.13±0.04）IU/ml和补体C4（0.39±0.01）IU/ml的水平升高（P < 0.05），而IgM（2.60±0.05）IU/ml无明显变化，差异无统计学意义（P > 0.05）。与脑梗死轻症组（14.11±2.09）PLU/ml和对照组（7.82±1.15）PLU/ml比较，脑梗死中重症组（16.88±2.50）PLU/ml血清ACA浓度提高，差异具有统计学意义（t = 9.153，P < 0.01）。与脑梗死轻症组和对照组比较，脑梗死中重症组总胆固醇[（1.75±0.03）mmol/L]和甘油三酯[（2.42±0.33）mmol/L]含量增加；高密度脂蛋白胆固醇[（0.41±0.03）mmol/L]含量降低；与对照组比较，脑梗死中重症组低密度脂蛋白胆固醇[（1.55±0.21）mmol/L]含量升高（P < 0.05）。通过细胞免疫参数与体液免疫参数之间的相关性分析显示呈负相关，且相关性曲线陡峭（P < 0.05）。

结论

脑梗死患者的细胞免疫与体液免疫的变化规律可指导脑梗死治疗和预后。

关键词: 脑梗死, 细胞免疫, 体液免疫, T淋巴细胞, 免疫球蛋白

Objective

To investigate the changes of cellular and humoral immune function in patients with cerebral infarction.

Methods

From May 2016 to May 2017, 120 patients with cerebral infarction admitted to the Central Hospital of Chancheng District were included and were divided into mild cerebral infarction group (middle cerebral artery infarction, the diameter of infarction area < 5 cm, n = 60) and medium and severe group (middle cerebral artery infarction, the diameter of infarction area > 5 cm, n = 60). 120 healthy persons were selected as healthy control group. Flow cytometry (FCM) and rate scattering immune transmission turbidimetric method were used to determine lgA, lgM and lgG, and the levels of complement C3 and C4 in each group. The levels of CD3⁺, CD4⁺, CD8⁺, NK cells, B cells and CD4⁺/CD8⁺ percentage in peripheral blood of patients with stroke were measured. The hemodynamic index and anticardiolipin antibody (ACA) concentration were measured. The biochemical changes in carotid atherosclerosis (CAS) reflected by ACA concentration were measured. One-way ANOVA was used for comparison between groups. The sex ratio of the patients was assayed with χ² test, the comparison between groups was chi-square analysis. The correlation between cellular immunity and humoral immunity was analyzed by linear correlation.

Results

The content of T lymphocyte in the severe cerebral infarction group was lower than that in the mild cerebral infarction group and the control group (P < 0.05). The percentage of CD8⁺ cells (27.91%±2.97%), the ratio of CD4⁺/CD8⁺ (1.98±0.03) were higher than that in the mild cerebral infarction group and the control group (P < 0.05). NK cells (12.29% ±1.58%) and B cells (12.76% ±2.00%) decreased in the severe group (P < 0.05). Compared with mild cerebral infarction group and control group, the serum levels of immunoglobulin IgG (10.60±1.06) IU/ ml decreased in the severe cerebral infarction group (P < 0.05), immunoglobulin IgA (4.01±0.35) IU/ ml, complement C3 (2.13±0.04) IU/ml and complement C4 (0.39±0.01) IU/ ml increased in severe cerebral infarction group (P < 0.05), but there was no significant difference in IgM (2.60±0.05) IU/ ml. Compared with mild cerebral infarction group (14.11±2.09) PLU/ml and control group (7.82±1.15) PLU/ml, serum ACA concentration in the severe cerebral infarction group (16.88±2.50) PLU/ml was increased (t = 9.153, P = 0.000). Compared with mild cerebral infarction group and control group, the contents of total cholesterol [(1.75±0.03) mmol/L] and triglyceride [(2.42±0.33) mmol/L] increased, the contents of high density lipoprotein cholesterol [(0.41±0.03) mmol/L] decreased, and the contents of low density lipoprotein cholesterol; (1.55 ±0.21) mmol/L) increased in moderate and severe cerebral infarction group (P < 0.05). The correlation analysis between cellular immune parameters and humoral immune parameters showed a negative correlation (P < 0.05).

Conclusion

The changes of cellular and humoral immunity in patients with cerebral infarction can guide the treatment and prognosis of cerebral infarction.

Key words: Cerebral infarction patients, Cellular immunity, Humoral immunity, Biochemical indices, Hemocyte immunoglobulin

表1 研究对象的一般资料（±s）

分组	例数	男/女	年龄（岁）
对照组	120	72/48	56.38±7.19
脑梗死轻症组	60	38/22	57.27±7.50
脑梗死中重症组	60	35/25	57.95±8.22
χ² / F值		0.665	0.922
P值		0.523	0.399

表1 研究对象的一般资料（±s）

分组	例数	男/女	年龄（岁）
对照组	120	72/48	56.38±7.19
脑梗死轻症组	60	38/22	57.27±7.50
脑梗死中重症组	60	35/25	57.95±8.22
χ² / F值		0.665	0.922
P值		0.523	0.399

表2 各组研究对象细胞免疫的情况测定结果（±s）

分组	例数	CD3⁺（%）	CD4⁺（%）	CD8⁺（%）	CD4⁺/CD8⁺	NK细胞（%）	B细胞（%）
对照组	120	56.33±8.21	39.81±4.10	21.66±5.17	0.84±0.11	27.45±2.13	19.71±3.16
脑梗死轻症组	60	40.03±4.16^a	23.20±3.52^a	24.75±2.15^a	1.21±0.02^a	15.81±1.12^a	15.79±1.57^a
脑梗死中重症组	60	45.22±5.53^ab	28.11±4.09^ab	27.91±2.97^ab	1.98±0.03^ab	12.29±1.58^ab	12.76±2.00^ab
F值		6.281	8.152	10.313	8.851	9.525	9.862
P值		0.005	0.002	0.001	0.000	0.000	0.000

表2 各组研究对象细胞免疫的情况测定结果（±s）

分组	例数	CD3⁺（%）	CD4⁺（%）	CD8⁺（%）	CD4⁺/CD8⁺	NK细胞（%）	B细胞（%）
对照组	120	56.33±8.21	39.81±4.10	21.66±5.17	0.84±0.11	27.45±2.13	19.71±3.16
脑梗死轻症组	60	40.03±4.16^a	23.20±3.52^a	24.75±2.15^a	1.21±0.02^a	15.81±1.12^a	15.79±1.57^a
脑梗死中重症组	60	45.22±5.53^ab	28.11±4.09^ab	27.91±2.97^ab	1.98±0.03^ab	12.29±1.58^ab	12.76±2.00^ab
F值		6.281	8.152	10.313	8.851	9.525	9.862
P值		0.005	0.002	0.001	0.000	0.000	0.000

表3 各组研究对象体液免疫的情况测定结果（IU/ml，±s）

分组	例数	IgG	IgA	IgM	C3	C4
对照组	120	14.12±1.33	2.81±0.19	2.11±0.05	1.64±0.01	0.29±0.01
脑梗死轻症组	60	12.11±1.52^a	3.12±0.42^a	2.25±0.02^a	1.91±0.02^a	0.34±0.02^a
脑梗死中重症组	60	10.60±1.06^ab	4.01±0.35^ab	2.60±0.05^ab	2.13±0.04^ab	0.39±0.01^ab
F值		7.258	13.102	5.213	8.808	7.253
P值		0.015	0.002	0.025	0.003	0.007

表3 各组研究对象体液免疫的情况测定结果（IU/ml，±s）

分组	例数	IgG	IgA	IgM	C3	C4
对照组	120	14.12±1.33	2.81±0.19	2.11±0.05	1.64±0.01	0.29±0.01
脑梗死轻症组	60	12.11±1.52^a	3.12±0.42^a	2.25±0.02^a	1.91±0.02^a	0.34±0.02^a
脑梗死中重症组	60	10.60±1.06^ab	4.01±0.35^ab	2.60±0.05^ab	2.13±0.04^ab	0.39±0.01^ab
F值		7.258	13.102	5.213	8.808	7.253
P值		0.015	0.002	0.025	0.003	0.007

表4 各组CAS常规生化指标测定结果（mmol/L，±s）

分组	例数	TC	TG	HDLC	LDLC
对照组	120	1.21±0.02	1.06±0.02	0.97±0.03	0.67±0.02
脑梗死轻症组	60	1.52±0.01^a	2.03±0.45^a	0.45±0.04^a	1.40±0.31^a
脑梗死中重症组	60	1.75±0.03^ab	2.42±0.33^ab	0.36±0.02^ab	1.55±0.21^ab
F值		6.122	7.214	8.227	7.855
P值		0.005	0.001	0.000	0.001

表4 各组CAS常规生化指标测定结果（mmol/L，±s）

分组	例数	TC	TG	HDLC	LDLC
对照组	120	1.21±0.02	1.06±0.02	0.97±0.03	0.67±0.02
脑梗死轻症组	60	1.52±0.01^a	2.03±0.45^a	0.45±0.04^a	1.40±0.31^a
脑梗死中重症组	60	1.75±0.03^ab	2.42±0.33^ab	0.36±0.02^ab	1.55±0.21^ab
F值		6.122	7.214	8.227	7.855
P值		0.005	0.001	0.000	0.001

图1 各组研究对象细胞免疫与体液免疫的相关性分析结果

1	Dargazanli C, Fahed R, Blanc R, et al. Modified thrombolysis in cerebral infarction 2C/thrombolysis in cerebral infarction 3 reperfusion should be the aim of mechanical thrombectomy:insights from the ASTER trial(contact aspiration versus stent retriever for successful revascularization)[J]. Stroke, 2018, 49(5):1189-1196.
2	Purroy A, Roncal C, Orbe J, et al. Matrix metalloproteinase-10 deficiency delays atherosclerosis progression and plaque calcification[J]. Atherosclerosis, 2018, 278(9):124-134.
3	Feitosa AS, Chaves MM, Veras DL, et al. Assessing the cellular and humoral immune response in Rhipicephalus sanguineus sensu lato(Acari:Ixodidae)infected with Leishmania infantum(Nicolle,1908)[J]. Ticks Tick Borne Dis, 2018, 9(6):1421-1430.
4	Pathinayake PS, Gayan WC, Lee HC, et al. Inactivated enterovirus 71 with poly-γ-glutamic acid/Chitosan nano particles(PC NPs)induces high cellular and humoral immune responses in BALB/c mice[J]. Arch Virol, 2018, 163(8):1-11.
5	赵志强，崔妍妍. 脑梗塞患者血清可溶性内皮细胞蛋白C受体和血管性假性血友病因子的表达及临床意义[J]. 中国实验诊断学, 2018, 22(6):970-973.
6	Zhou J, Hou X, Zhang H, et al. The clinical performance of a new chemiluminescent immunoassay in measuring anti-β2 glycoprotein 1 and Anti-Cardiolipin antibodies[J]. Med Sci Monit, 2018, 24(9):6816-6822.
7	Su J, Frostegård AG, Hua X, et al. Low levels of antibodies against oxidized but not nonoxidized cardiolipin and phosphatidylserine are associated with atherosclerotic plaques in systemic lupus erythematosus[J]. J Rheumatol, 2013, 40(11):1856-1864.
8	Assis VR, Monteiro TC, Queiroz-Hazarbassanov QG, et al. Corticosterone transdermal application in toads(Rhinella icterica):Effects on cellular and humoral immunity and steroid plasma levels[J]. J Exp Zool A Ecol Integr Physiol, 2017, 327(4):200-213.
9	Steiner S, Sadushi R, Bartok A, et al. Association of periprocedural neurological deficit in carotid stenting with increased anticardiolipin antibodies[J]. Thromb Res, 2009, 123(6):827-831.
10	翟洁敏，李会琪，何剑波, 等. 脑梗死合并感染患者血清皮质醇含量测定及其与神经功能,体液免疫,细胞免疫的相关性[J]. 海南医学院学报, 2016, 22(22):2669-2672.
11	庄献博，宋亚敏，王未飞, 等. 抗心磷脂抗体免疫球蛋白G和白细胞介素10及白细胞介素17与颅内大动脉粥样硬化性狭窄的相关性研究[J]. 中国脑血管病杂志, 2015 (12):636-641.
12	Rizka A, Setiati S, Harimurti K, et al. Effect of Alfacalcidol on Inflammatory markers and T Cell Subsets in Elderly with Frailty Syndrome: a Double Blind Randomized Controlled Trial[J]. Acta Med Indones, 2018, 50(3):215-221.
13	Wang J, Liu YM, Cao W, et al. Anti-inflammation and antioxidant effect of Cordymin, a peptide purified from the medicinal mushroom Cordyceps sinensis,in middle cerebral artery occlusion-induced focal cerebral ischemia in rats[J]. Metab Brain Dis, 2012, 27(2):159-165.
14	白润爱，康娟，古联. 疏血通对急性脑梗塞患者脑血流动力学,血清sICAM-1,IL-6,TNF-α的影响[J]. 昆明医科大学学报, 2016, 37(9):58-61.
15	方丽波，何洋，敖东慧, 等. 急性动脉粥样硬化性脑梗死患者外周血CD137的表达特点及其临床意义[J]. 中国神经免疫学和神经病学杂志, 2017, 24(5):335-338.
16	Wang S, Ma T, Wang L, et al. Effect of acupuncture on cerebrovascular reserve in patients with acute cerebral infarction:protocol for a randomized controlled pilot study[J]. Trials, 2017, 18(1):292.
17	Wang K, Zhang D, Wu J, et al. A comparative study of Danhong injection and Salvia miltiorrhiza injection in the treatment of cerebral infarction:A systematic review and meta-analysis[J]. Medicine, 2017, 96(22):e7079.

[1]	刘欢颜, 华扬, 贾凌云, 赵新宇, 刘蓓蓓. 颈内动脉闭塞病变管腔结构和血流动力学特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 809-815.
[2]	李昌金, 顾昊煜, 白辰光, 胡薇. 以腋窝肿块为主要表现的免疫球蛋白G4相关疾病三例[J]. 中华乳腺病杂志(电子版), 2023, 17(04): 254-257.
[3]	罗晨, 宗开灿, 李世颖, 傅应亚. 微小RNA-199a-3p调控CD4^＋T细胞表达参与肺炎支原体肺炎患儿免疫反应研究[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 569-574.
[4]	崔键, 戴庆. 基于肝囊型包虫病所致过敏反应模型研究Treg细胞数量比例与过敏反应的关系[J]. 中华普外科手术学杂志(电子版), 2023, 17(04): 427-430.
[5]	王静, 何彬. 经颅彩色多普勒超声联合血sCD40L、Fib、PAF对短暂性脑缺血发作后脑梗死的预测效果[J]. 中华神经创伤外科电子杂志, 2023, 09(04): 222-227.
[6]	刘宏达, 邵祥忠, 李林, 许小伟. 海安地区动脉粥样硬化性脑梗死患者CYP2C19基因多态性及与氯吡格雷抵抗的关系[J]. 中华神经创伤外科电子杂志, 2023, 09(04): 234-240.
[7]	许秀兰, 朱建建. 血压变异性与伴H型高血压的急性脑梗死患者预后不良的临床关系分析[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(04): 199-204.
[8]	马丽. CT灌注联合血管成像预测急性脑梗死患者近期神经功能预后的价值分析[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(04): 229-234.
[9]	符梅沙, 周玉华, 李慧, 薛春颜. 淋巴细胞免疫治疗对复发性流产患者外周血T淋巴细胞亚群分布与PD1/PD-L1表达的影响及意义[J]. 中华临床医师杂志(电子版), 2023, 17(06): 726-730.
[10]	宁丽娜, 熊杰. 醒脑开窍针刺法结合舌部针刺治疗脑梗死后构音障碍的疗效观察[J]. 中华针灸电子杂志, 2023, 12(04): 146-150.
[11]	丁晶, 李培雯, 许迎春. 醒脑开窍针刺法在神经急重症中的应用[J]. 中华针灸电子杂志, 2023, 12(04): 161-164.
[12]	朱敏, 李法强. 血清GFAP、UCH-L1联合VILIP-1水平对急性脑梗死神经功能预后不良的预测研究[J]. 中华脑血管病杂志(电子版), 2023, 17(05): 452-457.
[13]	李秦鹏, 王其涛, 朱媛媛, 周琦, 刘笑言, 许勇. 颈动脉彩色多普勒超声、颈部CT血管成像及脑部CT灌注成像在脑梗死并发颈动脉狭窄患者中的应用研究[J]. 中华脑血管病杂志(电子版), 2023, 17(05): 482-488.
[14]	邱甜, 杨苗娟, 胡波, 郭毅, 何奕涛. 亚低温治疗脑梗死机制的研究进展[J]. 中华脑血管病杂志(电子版), 2023, 17(05): 518-521.
[15]	李安, 张秀萍, 白波, 赵阳, 薛国芳, 李东芳. 主动脉夹层术后并发神经系统并发症二例及文献复习[J]. 中华脑血管病杂志(电子版), 2023, 17(04): 373-378.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Study on the changes of cellular immunity and humoral immunity in patients with cerebral infarction

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Study on the changes of cellular immunity and humoral immunity in patients with cerebral infarction