森林脑炎患者淋巴细胞亚群分类及细胞因子变化水平的临床研究

发布时间：2018-06-11 20:16

本文选题：森林脑炎 + 森林脑炎病毒　；参考：《内蒙古民族大学》2017年硕士论文

【摘要】：目的:本文通过流式微球捕获芯片技术及流式细胞术分别检测森林脑炎患者与健康体检者外周血细胞因子及淋巴细胞亚群水平,对森林脑炎患者组与对照组、森林脑炎患者病情中重度组与轻度组、急性期与恢复期之间进行比较分析,研究细胞因子及淋巴细胞亚群水平与森林脑炎免疫炎症反应的关系,对森林脑炎患者判断病情轻重、预后评估提供重要的免疫学指标。方法:(1)收集于内蒙古民族大学第二临床医学院(内蒙古林业总医院)神经内科2015年5月~2016年9月期间住院的患者,有蜱叮咬并明确诊断森林脑炎患者79例。参照职业性森林脑炎诊断标准GBZ88-2002,将TBE患者按照病情轻重不同分为中重度组28例和轻度组51例;根据患者病程时期不同分为急性期47例和恢复期32例。收集同时期来医院的健康体检者作为实验对照组20例。(2)采集患者急性期发病3天内和恢复期时血样3~5m L,装于EDTA抗凝紫帽管及含分离胶促凝黄帽管。(3)流式微球捕获芯片技术及流式细胞术分别检测森林脑炎患者外周血细胞因子及淋巴细胞亚群水平。(4)计数资料采用卡方检验;计量资料符合正态分布的样本用均数(标准差)表示,组间比较采用t检验;偏态分布的样本用中位数(四分位间距)表示,组间比较采用非参-独立样本秩和检验;α=0.05为检验水准。结果:(1)TBE患者组与对照组的差异(1)细胞因子:TBE患者组与对照组比较,血清IL-17A、IFN-γ、TNF-α、IL-10、IL-6、IL-4和IL-2水平明显升高,差异有统计学意义(p0.05)。(2)淋巴细胞亚群:TBE患者组与对照组比较,外周血B细胞百分比明显升高,差异有统计学意义(p0.05);而CD3~+、CD8~+、CD4~+、CD4~+/CD8~+、NK和Treg细胞指标在两组之间差异无统计学意义(p0.05)。(2)TBE患者中重度组与轻度组的差异(1)细胞因子:TBE患者中重度组与轻度组比较,血清IL-6水平明显升高,差异有统计学意义(p0.05);而IL-17A、IFN-γ、TNF-α、IL-10、IL-4和IL-2水平在两组之间差异无统计学意义(p0.05)。(2)淋巴细胞亚群:TBE患者中重度组与轻度组比较,外周血CD3和CD8指标明显降低,B和Treg细胞百分比明显升高,差异有统计学意义(p0.05);而CD4~+、CD4~+/CD8~+和NK细胞指标在两组之间差异无统计学意义(p0.05)。(3)TBE患者急性期与恢复期的差异(1)细胞因子:TBE患者急性期与恢复期比较,血清IL-6水平明显升高,差异有统计学意义(p0.05);而血清IL-17A、IFN-γ、TNF-α、IL-10、IL-4和IL-2水平在两组之间差异无统计学意义(p0.05)。(2)淋巴细胞亚群:TBE患者急性期与恢复期比较,外周血CD3~+、CD8~+指标明显降低,CD4~+、CD4~+/CD8~+和B细胞指标明显升高(p0.05);而NK和Treg细胞百分比在两组之间差异无统计学意义(p0.05)。结论:(1)森林脑炎患者外周血IL-17A、IFN-γ、TNF-α、IL-10、IL-6、IL-4、IL-2及B细胞水平变化,可能在森林脑炎免疫发病机制中发挥重要作用。(2)外周血IL-6及CD3~+、CD8~+、B和Treg细胞指标在TBE患者中重度组明显变化,可作为森林脑炎患者判断病情轻重的指标。(3)外周血IL-6及CD3~+、CD8~+、D4+、CD4~+/CD8~+、B细胞指标变化,可作为森林脑炎患者预后评估的指标。
[Abstract]:Objective: To investigate the level of peripheral blood cytokines and lymphocyte subsets in the patients with forest encephalitis and health examiners by flow microsphere capture chip technology and flow cytometry, and to compare and analyze the patients with forest encephalitis and the control group, the severe group and the mild group, the acute period and the recovery period, and the study of the patients with forest encephalitis. The relationship between cell factor and lymphocyte subgroup level and immune inflammatory response of forest encephalitis can provide important immunological indexes for judging the severity and prognosis of forest encephalitis patients. Methods: (1) collected in the neurology department of the second clinical medicine hospital of Inner Mongolia University for the Nationalities (Inner Mongolia General Hospital of Lin Ye) in September ~2016 May 2015. In the hospital, there were 79 patients with tick bite and definite diagnosis of forest encephalitis. According to the diagnostic standard of occupational forest encephalitis GBZ88-2002, the patients were divided into 28 cases and 51 mild groups according to the severity of the disease. 47 cases of acute period and 32 cases were divided into 32 cases according to the period of disease course. 20 cases were used as the experimental control group. (2) the blood sample 3~5m L was collected within 3 days and the convalescence period of the patients during the acute period, which was installed in the EDTA anticoagulant purple caps tube and the separating glue promoting yellow cap tube. (3) the flow cytometry and flow cytometry were used to detect the peripheral blood cell factor and lymphocyte subgroup in the peripheral blood of the patients with forest encephalitis. (4) the counting data were collected. Using the chi square test; the measurement data conformed to the normal distribution of the sample average number (standard deviation), and the t test was used in the group. The sample used in the partial distribution was expressed as the median (four division spacing), the group was compared with the non parametric independent sample rank and test; the alpha =0.05 was the test level. (1) the difference between the TBE patient group and the control group (1) the cytokine: TB Compared with the control group, the level of serum IL-17A, IFN- gamma, TNF- a, IL-10, IL-6, IL-4 and IL-2 increased significantly in the E patients group, and the difference was statistically significant (P0.05). (2) the lymphocyte subgroup: the percentage of B cells in the peripheral blood increased significantly in the peripheral blood, and the difference was statistically significant (P0.05). The difference between the two groups was not statistically significant (P0.05). (2) the difference between the moderate and severe group of TBE patients (1) cytokine: the level of serum IL-6 in the moderate and severe group of TBE patients was significantly higher than that in the mild group, and the difference was statistically significant (P0.05), while IL-17A, IFN- gamma, TNF- a, IL-10, IL-4 and IL-2 were not statistically different among the groups. Significance (P0.05). (2) lymphocyte subsets: compared with mild group, the index of CD3 and CD8 in peripheral blood significantly decreased and the percentage of B and Treg cells increased significantly (P0.05), while CD4~+, CD4~+/CD8~+ and NK cell indexes were not statistically significant (P0.05). (3) acute and recovery phase of TBE patients. Difference (1) cytokine: TBE patients' acute phase and recovery period, serum IL-6 level was significantly higher, the difference was statistically significant (P0.05), while serum IL-17A, IFN- gamma, TNF- a, IL-10, IL-4 and IL-2 levels were not statistically significant between the two groups (P0.05). (2) lymphocyte subgroups: TBE patients compared with the recovery period, peripheral blood CD3~+ The index of 8~+, CD4~+, CD4~+/CD8~+ and B cells increased significantly (P0.05), while the percentage of NK and Treg cells had no significant difference between the two groups (P0.05). Conclusion: (1) the peripheral blood IL-17A, IFN- gamma, TNF- alpha in the peripheral blood of the patients with forest encephalitis may play a role in the immune pathogenesis of forest encephalitis. (2) the indexes of IL-6 and CD3~+, CD8~+, B and Treg in peripheral blood were significantly changed in the moderate and severe group of TBE patients. It could be used as an index to judge the severity of the disease in the patients with forest encephalitis. (3) the peripheral blood IL-6 and CD3~+, CD8~+, D4+, CD4~+/CD8~+, and the changes of B cell indexes could be used as indicators for evaluating the prognosis of the patients with forest encephalitis.
【学位授予单位】：内蒙古民族大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.34

【参考文献】