自发性蛛网膜下腔出血患者CD4+CD25+调节性T细胞变化特点与意义

摘要

目的 探讨CD4+CD25+节性T细胞(Treg)在自发性蛛网膜下腔出血(SAn)发病的作用.方法 收集自发性(A组)及外伤性(B组)SAn患者各15例,并选取15例头痛查因而行腰穿最后被证实为非器质性神经系统病变的患者作为对照(C组).使用流式细胞术检测以上3组外周血及脑脊液内Treg及其胞内细胞因子白介素-10(IL-10)及转化生长因子p1(TGF-β1)的百分含量.比较自发性及外伤性SAH患者格拉斯哥评分(GCS)、神经功能缺损评分(NIHSS)、头痛视觉评分(VAS)及住院时间的差异,并进行相关性分析.结果 (1)自发性SAH患者外周血及脑脊液内Treg、IL-10及TGF-p1的含量均明显低于外伤性SAH组及头痛对照组(P＜0.05),但外伤性SAH组以上三者却与头痛对照组无统计学差异(P＜0.05)；(2)随着治疗的进展,SAH患者的Treg含量呈进行性上升趋势,前2次腰穿两组患者脑脊液Treg含量存在统计学差异,以自发性SAH偏低(P＜0.05),但第3及第4次腰穿脑脊液的Treg含量无组间差异,且第3及第4次腰穿的脑脊液Treg含量明显高于第一及第二次(P＜0.05)；(3)自发性SAH组的GCS、NIHSS、VAS及住院时间均显著少于(短于)外伤组；(4)相关性分析显示Treg、IL-10及TGF-β1三者当中的任意一者与NIHSS、VAS及住院时间之间四者当中的任意一者呈负相关性,但与GCS呈显著正相关性(r绝对值均大于0.6,P均小于0.05).结论 CD4+CD25调节性T细胞数量的减少可能是自发性SAH的一个重要机制；该细胞含量越高,自发性SAH患者预后越好.%Objective To explore the role of CD4+CD25+ regulatory T cells (Treg) in the occurrecne of spontaneous subarachnoid hemorrhage (SAH).Methods Fifteen patients with spontaneous SAH,15 with traumatic SAH,and 15 with headache without organic pathologies as confirmed by lumbar puncture (control group) were examined with flow cytometry for Treg in the peripheral blood and cerebrospinal fluid and intracellular cytokine interleukin-10 (IL-10) and transforming growth factor beta1 (TGF-β1) levels.The Glasgow score (GCS),neurological deficit score (NIHSS),headache,visual analog scale (VAS) and hospitalization time were compared between the two SAH groups.Results Spontaneous SAH patients showed significantly lowered peripheral blood Treg,IL-10,and TGF-β1 in the cerebrospinal fluid compared with the patients with traumatic SAH and the control group (P＜0.05),and the 3 measurements were comparable between the latter two groups (P＞0.05).After administration of treatment,of Treg content in spontaneous SAH patients increased progressively and became comparable with those in the other two groups at the third and fourth lumbar punctures.Spontaneous SAH patients showed significantly lower GCS,NIHSS,and VAS with shorter hospital stay than the traumatic SAH patients.Correlation analysis showed that Treg,IL-10 and TGF-β1 were all inversely correlated with NIHSS,VAS,and duration of hospitalization but positively correlated with GCS (the absolute r values were all greater than 0.6,P＜0.05).Conclusion Treg deficiency can be an important mechanism for the occurrence of spontaneous SAH,and a higher level of Treg indicates a better outcome of the patients.