摘 要 目的：探討急性脑卒中发病不同时间T细胞亚群的变化及对预后判断的作用。方法：选取急性脑卒中患者200例，其中急性脑梗死100例，脑出血100例，根据美国国立卫生院卒中评分量表（NIHSS）评分分为轻、中、重型，分别在发病24 h、3 d、7 d时测定血浆CD3+、CD4+、CD8+值以及CD4+/CD8+比值，观察其水平变化，同时观察脑卒中相关性肺炎（SAP）的发生率及治疗90 d后转归情况。结果：100例急性脑梗死患者中有34例为重型，其中24例重型患者发病3 d时CD3+、CD4+、CD8+值明显下降（P<0.01），发病7 d时CD3+、CD4+、CD8+值有所上升（P<0.05）。100例急性脑出血患者中有40例为重型，其中28例重型患者发病24 h时CD3+、CD4+、CD8+值轻度下降（P<0.05），发病3 d时CD3+、CD4+、CD8+值明显下降（P<0.01），发病7 d时CD3+、CD4+、CD8+值有所上升（P<0.05）。在急性脑卒中重型患者中，T细胞亚群下降者52例中并发SAP 49例，而T细胞亚群正常者22例中并发SAP 9例（P<0.05）；治疗90 d后，52例T细胞亚群下降者中转归良好12例，转归不良40例，22例T细胞亚群正常者中转归良好12例，转归不良10例，两者转归不良差异有统计学意义（P<0.05）。结论：急性脑卒中在发病不同时间T细胞亚群有一定比例下降，尤其是重症脑卒中患者需高度重视，可动态监测T细胞亚群的变化，预防SAP的发生，改善预后。
关键词 急性脑卒中；脑卒中相关性肺炎；T细胞亚群；预后
中图分类号：R743 文献标志码：A 文章编号：1006-1533（2021）16-0019-03
Clinical significance and prognostic judgment of T cell subsets detection in acute stroke
XIONG Yan1， CAO Minghua1， WU Mingchao1， HUANG Chengpeng1， WANG Lu1， WU Huiyun2（1. Department of Internal Medicine-Neurology of the First People’s Hospital of Jingdezhen City， Jiangxi Province 333000， China； 2. Clinical Laboratory of the First People’s Hospital of Jingdezhen City， Jiangxi Province 333000， China）
ABSTRACT Objective： To investigate the changes of T cell subsets at different time points of acute stroke and the role of prognostic judgment. Methods： Two hundred patients with acute stroke were selected， including 100 patients with acute cerebral infarction and 100 patients with cerebral hemorrhage， according to the National Institutes of Health Stroke Scale（NIHSS） score， were divided into mild， moderate and severe types. The plasma CD3+， CD4+， CD8+ values and the CD4+/CD8+ ratio were measured at 24 h， 3 d， and 7 d after the onset of disease to observe the level changes， and at the same time， the incidence of strokeassociated pneumonia（SAP） and the outcome after 90 days of treatment were observed. Results： Among the 100 patients with acute cerebral infarction， 34 cases were severe， and the values of CD3+， CD4+， CD8+ in 24 patients with severe cerebral infarction decreased significantly on the 3rd day of onset（P<0.01）， the CD3+， CD4+， CD8+ values increased on the 7th day of onset（P<0.05）. Among the 100 cases of acute cerebral hemorrhage， 40 cases were severe， and the CD3+， CD4+， CD8+ values of 28 cases of severe patients decreased slightly at 24 hours after onset（P<0.05）， the CD3+， CD4+， and CD8+ values decreased significantly on the 3rd day of onset（P<0.01）， the CD3+， CD4+， and CD8+ values increased on the 7th day of onset（P<0.05）. In severe acute stroke patients， among the 52 cases with decreased T cell subsets， 49 cases were complicated with SAP， in 22 cases of normal T cell subsets， 9 cases were complicated by SAP（P<0.05）. After 90 days of treatment， among 52 cases with decreased T cell subsets， 12 had good outcomes and 40 had poor outcomes， and among the 22 cases of normal T cell subsets， 12 had good outcomes and 10 had poor outcomes. The difference in poor outcomes was statistically significant（P<0.05）. Conclusion： The proportion of T cell subsets decreases in different time of acute stroke， especially the patients with severe stroke need to be paid great attention to， and the changes of T cell subsets can be dynamically monitored to prevent the occurrence of SAP and improve the prognosis.
KEY WORDS acute stroke； stroke associated pneumonia； T cell subsets； prognosis
脑卒中急性期，损伤脑组织释放炎性介质触发炎性级联反应，进一步加重脑损伤，随后卒中可诱导免疫抑制以减轻炎性反应并发挥脑保护作用，T细胞亚群在脑卒中后出现一系列变化，参与脑卒中后免疫功能调节。本研究检测200例急性脑卒中患者T细胞亚群的变化，并探讨其临床意义以及与预后的关系。
