阿替普酶修复急性缺血性脑卒中后T淋巴细胞介导的脑组织免疫炎症损伤的成效研究OA北大核心CSTPCD
Efficacy of Alteplase in repairing T-lymphocyte mediated brain tissue immunoinflammatory damage after acute ischemic stroke
目的:研究阿替普酶修复急性缺血性脑卒中(AIS)后T淋巴细胞介导的脑组织免疫炎症损伤.方法:选取2022年6月至2023年6月衡水市人民医院收治的AIS患者100例,分为常规组、阿替普酶组,每组50例,入组后常规组行常规措施干预治疗,阿替普酶组加用阿替普酶溶栓治疗.比较两组患者神经功能、脑血管储备功能、脑部血流动力学、T淋巴细胞介导脑组织免疫炎症损伤指标CD4+T细胞亚群[促炎细胞(Th1、Th17)、抗炎细胞(Th2、Treg细胞)]及其相关细胞因子水平变化,评价临床疗效及预后转归情况.结果:治疗后阿替普酶组神经功能NIHSS评分低于常规组[(6.57±0.79)分 vs(9.34±1.23)分,t=13.400,P<0.05].阿替普酶组脑血管储备功能CVR、BHI高于常规组[(34.54±4.35)%vs(29.89±2.31)%、1.00±0.23 vs 0.92±0.08,t=6.676、2.323,P<0.05],PI低于常规组(0.60±0.07 vs 0.72±0.08,t=7.982,P<0.05).阿替普酶组脑部血流动力学CBF高于常规组[(49.89±9.76)ml/(100 g/min)vs(40.34±7.86)ml/(100 g/min),t=5.389,P<0.05],MTT、TTP短于常规组[(6.45±0.78)s vs(9.78±1.02)s、(24.45±2.16)s vs(26.78±3.25)s,t=18.340、4.222,P<0.05].阿替普酶组Th1、Th17细胞比例及相关细胞因子IFN-γ、IL-17水平低于常规组[(3.27±0.59)%vs(5.64±0.52)%、(2.34±0.25)%vs(4.35±0.38)%、(3.24±0.45)pg/ml vs(4.90±0.65)pg/ml、(10.23±1.43)pg/ml vs(14.35±2.14)pg/ml,t=21.310、31.250、14.850、11.320,P<0.05],Th2、Treg细胞比例及相关细胞因子IL-4、TGF-β水平高于常规组[(8.75±0.54)%vs(7.02±0.37)%、(7.24±2.13)%vs(5.88±1.67)%、(13.24±2.16)pg/ml vs(10.26±1.29)pg/ml、(90.32±9.02)pg/ml vs(81.45±8.97)pg/ml,t=18.690、3.553、8.375、4.930,P<0.05].阿替普酶组总有效率、预后良好率高于常规组(94.00%vs 80.00%、80.00%vs 62.00%,χ2=4.332、3.934,P<0.05).结论:阿替普酶在AIS治疗中具有修复T淋巴细胞介导的脑组织免疫炎症损伤的作用,可减轻脑损伤,改善脑血管储备功能和神经功能,预后转归良好.
Objective:To study the efficacy of Alteplase in repairing T-lymphocyte mediated brain tissue immunoinflammatory damage after acute ischemic stroke(AIS).Methods:A total of 100 patients with AIS admitted to Hengshui People's Hospital from June 2022 to June 2023 were selected,and divided into regular group and Alteplase group,with 50 cases in each group,after enroll-ment,the regular group received routine intervention treatment,while the Ateplase group received thrombolytic therapy with Ateplase.Compared changes in neurological function,cerebrovascular reserve function,cerebral hemodynamics,T lymphocytes mediated brain tissue immunoinflammatory damage indicators CD4+T cell subsets[pro-inflammatory cells(Th1,Th17),anti-inflammatory cells(Th2,Treg cells)]and related cytokines levels between two groups of patients,and evaluated clinical efficacy and prognosis.Results:After treatment,NIHSS score of Alteplase group was lower than that of regular group[(6.57±0.79)points vs(9.34±1.23)points,t=13.400,P<0.05].CVR and BHI of cerebral vascular reserve in Alteplase group were higher than those in regular group[(34.54±4.35)%vs(29.89±2.31)%,1.00±0.23 vs 0.92±0.08,t=6.676,2.323,P<0.05],PI was lower than that of regular group(0.60±0.07 vs 0.72±0.08,t=7.982,P<0.05).Cerebral hemodynamic CBF of Alteplase group was higher than that of regular group[(49.89±9.76)ml/(100 g/min)vs(40.34±7.86)ml/(100 g/min),t=5.389,P<0.05].MTT and TTP were shorter than those in regular group[(6.45±0.78)s vs(9.78±1.02)s,(24.45±2.16)s vs(26.78±3.25)s,t=18.340,4.222,P<0.05].Proportion of Th1 and Th17 cells and levels of IFN-γ and IL-17 in Ateplase group were lower than those in regular group[(3.27±0.59)%vs(5.64±0.52)%,(2.34±0.25)%vs(4.35±0.38)%,(3.24±0.45)pg/ml vs(4.90±0.65)pg/ml,(10.23±1.43)pg/ml vs(14.35±2.14)pg/ml,t=21.310,31.250,14.850,11.320,P<0.05),proportion of Th2 and Treg cells and levels of IL-4 and TGF-β were higher than those in regular group[(8.75±0.54)%vs(7.02±0.37)%,(7.24±2.13)%vs(5.88±1.67)%,(13.24±2.16)pg/ml vs(10.26±1.29)pg/ml,(90.32±9.02)pg/ml vs(81.45±8.97)pg/ml,t=18.690,3.553,8.375,4.930,P<0.05].Total effective rate and good prognosis rate of Alteplase group were higher than those of regular group(94.00%vs 80.00%,80.00%vs 62.00%,χ2=4.332,3.934,P<0.05).Conclu-sion:In treatment of AIS,Alteplase has effect of repairing the immune inflammation injury of brain tissue mediated by T lymphocytes,alleviating brain injury,improving cerebrovascular reserve function and nerve function,and the prognosis is good.
王建宇;张莉;王勇朝;魏琰
衡水市人民医院,衡水 053000
临床医学
阿替普酶急性缺血性脑卒中T淋巴细胞免疫炎症损伤
AlteplaseAcute ischemic strokeT lymphocytesImmunoinflammatory injury
《中国免疫学杂志》 2024 (007)
1484-1489 / 6
衡水市科技计划项目(2019014061Z).
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