摘要
目的:脑卒中是一种致残率和死亡率都很高的神经系统疾病,已经成为威胁人类健康的主要原因之一,大约70%的脑卒中为缺血性卒中,其病因尚不完全清楚,是由遗传和环境因素共同作用的复杂疾病。国内外许多研究认为,炎症反应在其发病机制中发挥重要作用,本研究通过检测急性脑梗死患者外周血中白细胞介素-2(interleukin-2, IL-2)、干扰素-γ(interferon gamma, IFN-γ)、C-反应蛋白(C-reactive protein, CRP)的含量,揭示其在急性脑梗死的发生发展中的作用;探讨梗死体积与炎症反应的关系;揭示IL-2、IFN-γ、CRP与神经功能缺损程度评分、3个月后改良的Rankin生活能力量表评分、血脂、血糖的关系,为急性脑梗死的预防和治疗提供新的思路和方法。
方法:依据1995年中华医学会第四届全国脑血管病会议修订的各类脑血管病诊断要点[1],选择2009年1月至2009年12月间在我院神经内科住院的急性脑梗死患者41例,男27例,女14例,所有患者均经头颅CT和(或)MRI扫描确诊为急性脑梗死,排除由脑肿瘤、脑外伤、冠心病和其他心脏病合并心房颤动引起的脑栓塞、脑寄生虫病等。根据梗死体积大小分为2组:中小体积梗死组(小于等于10.0cm3)、大体积梗死组(大于10.0 cm3);按照美国国立卫生院神经功能缺损评分(NIHSS)对入选患者进行神经功能缺损程度评分,于发病3个月后对患者随访,进行改良的Rankin生活能力量表评分。另选年龄、性别相匹配的同期门诊健康体检者20例作为健康对照组。采用流式细胞技术检测外周血中CD4+T淋巴细胞内IL-2、IFN-γ含量,采用免疫散射比浊法检测外周血CRP的浓度。计量资料采用均数±标准差表示,采用SPSS13.0统计软件进行t检验、相关分析等,检验水准为双侧P<0.05。
结果:1.急性脑梗死患者外周血CRP、CD4+T淋巴细胞内IFN-γ含量均高于健康对照组,且大体积脑梗死组外周血CRP、CD4+T淋巴细胞内IFN-γ含量高于中小体积脑梗死组。2.急性脑梗死患者外周血CD4+T淋巴细胞内IL-2含量与健康对照组比较差别无统计学意义。3.急性脑梗死患者外周血CRP、CD4+T淋巴细胞内IL-2、IFN-γ含量与外周血白细胞计数呈正相关,与入院时NIHSS评分,发病3个月后改良的Rankin生活能力量表评分呈正相关,均有统计学意义;4.外周血CD4+T淋巴细胞内IL-2含量与血糖、胆固醇、低密度脂蛋白呈正相关,无统计学意义,与甘油三酯呈正相关,有统计学意义;CD4+T淋巴细胞内IFN-γ含量与胆固醇、甘油三酯呈正相关,无统计学意义,与血糖、低密度脂蛋白呈正相关,有统计学意义。外周血CRP含量与血糖、胆固醇呈正相关,无统计学意义,与甘油三酯、低密度脂蛋白呈正相关,有统计学意义。
结论: 1.外周血CRP、CD4+T淋巴细胞内IFN-γ均参与了急性脑梗死的病理、生理过程,而且还可能参与了脑水肿的形成。2.急性脑梗死患者外周血CRP、CD4+T淋巴细胞内IL-2、IFN-γ水平高低可反应脑梗死患者的严重程度,并能协助评估患者预后。3.急性脑梗死患者外周血CRP、CD4+T淋巴细胞内IL-2、IFN-γ与血脂、血糖存在一定的相关性。
Objective: As a very high morbidity and mortality nervous system diseases, stroke has become one of the main threats to human health, about 70% of the stroke is ischemic stroke and it caused by genetic and environmental factors. Studies at home and abroad suggest that inflammation play an important role in the pathogenesis. In this study we want to reveal the role of cytokines in the occurrence and development of acute cerebral infarction by testing interleukin-2, interferon-γ, C-reactive protein levels in peripheral blood, discussion the relationship between infarction volumes and inflammatory reaction; and further reveal the relationship betweenIL-2, IFN-γ, CRP and neurologic impairment degree score, the modified Rankin scale score, blood lipids, blood sugar. As to provide new ideas and methods for prevention and treatment of acute cerebral infarction.
Methods: According to the diagnostic standard mended in the Fourth Cerebrovascular Disease Meeting [1], we select 41 patients with acute cerebral infarction at the neurology department of our hospital from January 2009 to December 2009, 27 males and 14 females, all patients were confirmed in clinical and scanned by CT and (or) MRI, exclude brain parasites, cerebral embolism caused by brain tumor, brain trauma, coronary heart disease and other heart disease with atrial fibrillation. According to the volumes of infarction, they were divided into two groups: little and mediun volumes group, large volumes group. We do the clinical neurologic impairment degree score, three months later we do the modified Rankin scale score. 20 persons with matched clinical data, such as age, sex were selected as normal control group. In all subjects, the peripheral blood levels of IL-2 and IFN-γwere detected by flow cytometry (FCM), the levels of CRP were detected by immune nephelometry. All data were reported as mean±standard deviation, the chief statistical indexes were tested by the 13.0 SPSS software package, using Student t-test and Bivariate correlate. P <0.05 was considered statis- tically significant.
Results: 1. The peripheral blood CRP, IFN-γin CD4 + T lymphocytes levels in the patients with ACI were significantly higher than that in the healthy control group (P <0.05), and the levels in the patients of large volumes group were significantly higher than that in the little and mediun volumes group (P <0.05). 2. The peripheral blood IL-2 in CD4 + T lymphocytes levels in the patients with ACI compared with healthy control group has no statistically significant. 3. There was statistically significant in peripheral blood CRP, IL-2, IFN-γin CD4 + T lymphocytes levels with WBC count, neurologic impairment degree score, modified Rankin scale score. 4. The peripheral blood IL-2 in CD4 + T lymphocytes levels correlated with TG, not correlated with blood sugar, cholesterol, low-density lipoprotein; IFN-γlevels correlated with blood sugar, low-density lipoprotein, not correlated with cholesterol, TG; and peripheral blood CRP levels correlated with TG, low-density lipoprotein, not correlated with blood sugar, cholesterol.
Conclusion: 1. The peripheral blood CRP, IFN-γin CD4 + T lympho- cytes involved in the pathophysiological process of acute cerebral infarction, and also they may participate in the formation of edema. 2. The peripheral blood levels of CRP, IL-2, IFN-γin CD4 + T lymphocytes would be helpful for estimating the severity of ACI and aprognostic factor. 3. There are varying degrees of correlation between the peripheral blood CRP, IL-2, IFN-γin CD4 + T lymphocytes and blood lipids, blood sugar.
引文
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