急性脑梗死患者血清C反应蛋白/脂联素和T细胞亚群与临床预后及神经功能的关系-东南大学学报医学版

急性脑梗死患者血清C反应蛋白/脂联素和T细胞亚群与临床预后及神经功能的关系

单位：苏州大学附属第三医院暨常州第一人民医院急诊科, 江苏常州 213000

分类号：R743.33

出版年·卷·期（页码）：2018·37·第一期（101-106）

摘要：

目的：探讨急性脑梗死患者血清中C反应蛋白（CRP）/脂联素（APN）、T细胞亚群与临床预后及神经功能的关系。方法：选取我院2013年9月~2016年9月间收治267例急性脑梗死患者为研究对象，分为预后不良组（观察1组）及预后良好组（对照1组）及NIHSS评分≤19分组（观察2组）及≥NIHSS评分20分组（对照2组）。所有患者入院后监测患者血清中CRP、APN水平、辅助性T细胞水平（辅助性Th17细胞、调节性Treg细胞）。结果：观察1组和2组患者血清CRP、CRP/APN水平分别高于对照1组和2组，而观察1组和2组APN水平低于对照1组和2组（P<0.05）；观察1组和2组Th17细胞和Th17/Treg分别低于对照1组和2组（P<0.05）。采用logisitic回归分析探讨影响急性脑梗死预后和NIHSS评分的因素，多因素分析提示CRP/APN和Treg细胞/Th17细胞是急性脑梗死患者死亡的独立危险因素。结论：血清中CRP/APN水平及T细胞亚群与急性脑梗死患者临床预后和NIHSS评分密切相关，是临床预后和NIHSS评分的独立危险因素。

Objective: To investigate the relationship between the levels of C reactive protein (CRP) and adiponectin (APN) and prognosis and NIH stroke scale(NIHSS) in patients with acute cerebral infarction.Methods: 267 cases of acute cerebral infarction patients in our hospital from September 2015 to September 2016 were selected as subjects. The study subjects were divided into 2 groups with poor prognosis (the observation 1 group) and good prognosis (the control 1 group) and 2 groups with NIHSS ≤ 19 (the observation 2 group) and NIHSS ≥ 20(the control 2 group). All patients were monitored for CRP, APN level, and auxiliary T cell level (auxiliary Th17 cells, regulatory Treg cells) in serum. Result: The serum CRP and CRP/APN levels in the observation 1 group and the observation 2 group were much higher than that of the control 1 group and the control 2 group (P<0.05). The Th17 and Th17/Treg cells in the observation 1 group and the observation 2 group were significantly lower than that of the control 1 group and the control 2 group (P<0.05). The multivariate analysis showed that CRP/APN and Treg/Th17 were independent risk factors of both prognosis and NIHSS. Conclusion: The clinical outcomes of CRP/APN level and T cell subgroups in serum were closely related to the clinical prognosis of patients with acute cerebral infarction and NIHSS score, which were independent risk factors for clinical prognosis and NIHSS score.

参考文献：

[1] 刘全生,张雯凌.可溶性CD40L水平对急性脑梗死患者颈动脉粥样硬化斑块稳定性的影响[J].中国实用神经疾病杂志,2016,19(7):12-13.
[2] 张立,黄旌,李蒙,等.急性脑梗死患者康复期应用普罗布考联合阿托伐他汀辅助治疗对血清学指标的影响[J].海南医学院学报,2016,22(11):1160-1163.
[3] 陈然,张骏,袁胜山,等.急性脑梗死患者血清可溶性CD40L与C-反应蛋白含量的改变及其意义[J].临床神经病学杂志,2009,22(5):344-346.
[4] 林美容,李世博,余碧晖,等.依达拉奉对急性脑梗死患者神经功能及血清超敏C反应蛋白水平的影响[J].广东医学,2016,37(Z1):214-215.
[5] 关文锋,石青,陈杰明,等.APN及sICAM 1在急性脑梗死病人发病中的作用[J].中西医结合心脑血管病杂志,2016,14(10):1163-1165.
[6] 贺兰兰.血清APN水平与急性脑梗死患者颈动脉粥样硬化斑块相关性研究[J].现代诊断与治疗,2016,27(18):3439-3440.
[7] 中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中华神经科杂志,2010,43(2):146-153.
[8] 王建伟,陈红芳.中国急性缺血性脑卒中诊治指南新旧版本比较[J].浙江实用医学,2016,21(3):233-235.
[9] 邓丽,刘晓冬,张拥波,等.急性脑梗死的治疗进展[J].中国全科医学,2011,14(8):825-829.
[10] 卢玉振,林森,胡得飞,等.Hcy、hs-CRP联合检测在冠心病和急性脑梗死患者中的预测价值[J].中国实验诊断学,2015,(3):386-388.
[11] 诸越瑾,张华,姚洪锋,等.Hcy、MPV、hs-CRP及FIB对急性脑梗死诊断的价值[J].检验医学,2015,(12):1219-1221.
[12] 蔡丽萍.急性脑梗死患者血清sICAM-1、ET、MCP-1及APN的临床研究[J].中国基层医药,2013,20(5):662-664.
[13] 孙德锦,曾庆宏,姜建东,等.急性脑梗死急性期患者辅助性T细胞亚群及其细胞因子IFN-γ、IL-4的变化及意义[J].北京医学,2016,38(2):105-109.
[14] 刘贵香,姚平波,张平,等.急性脑梗死患者外周血Th17细胞与调节性T细胞的表达水平与预后的关系[J].广东医学,2014,(7):1027-1029.
[15] 蒋福生,张平,张新华,等.急性脑梗死患者免疫调节性T淋巴细胞表达与预后的关系[J].中国动脉硬化杂志,2013,21(10):923-926.
[16] MUNUSWAMY-RAMANUJAM G,DAI E,LIU L,et al.Neuroserpin,a thrombolytic serine protease inhibitor(serpin),blocks transplant vasculopathy with associated modification of T-helper cell subsets[J].Thromb Haemost,2010,103(3):545-555.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录