卒中T淋巴细胞亚群动态变化及其与卒中相关感染的关系

目的 观察卒中急性期患者外周血中C D 3 +T细胞、C D 3 + C D 4 +T细胞、C D 3 + C D 8 +T细胞及 CD4+CD25+FoxP3+调节性T细胞（regulatory T cells，Tregs）的动态变化，探讨卒中后机体免疫状态及其 对卒中后感染的影响。 方法 选取卒中急性期患者32例为卒中组，根据发病1周内是否发生感染，将患者分为卒中后非感 染组24例和卒中后感染组8例。另选取性别、年龄匹配的健康体检者23例为对照组。采用流式细 胞术分别于病程24 h内、3 d、7 d检测卒中患者和健康体检者外周血中CD3+T细胞、CD3+CD4+T细胞、 CD3+CD8+T细胞及Tregs水平。 结果 ① 与对照组比较，卒中后非感染组CD3+CD4+T细胞与Tregs于发病后7 d升高（P分别为0.02和 0.03）；CD3+CD8+T细胞在发病后24 h及3 d下降（P分别为0.01和0.03），发病后7 d升至与健康对照组 无显著差异。卒中后感染组CD3+T细胞、CD3+CD4+T细胞、CD3+CD8+T细胞及Tregs在发病24 h内（P分别为 ＜0.001，＜0.001，0.03和＜0.001）、3 d（P均＜0.001）、7 d（P分别为＜0.001，0.01，0.01和0.01）均较健 康对照组明显下降；②卒中后感染组CD3+T细胞、CD3+CD4+T细胞及Tregs在发病后24 h内（P分别为0.01， ＜0.001和＜0.001）、3 d（P分别＜0.001，＜0.001和0.04）、7 d（P均＜0.001）均显著低于卒中后非感染 组；两组CD3+CD8+T细胞在发病后24 h内无明显差异，但3 d（P＜0.001）、7 d（P =0.02）卒中后感染组显 著低于卒中后非感染组。 结论 C D3+T淋巴细胞、CD3+CD4+T淋巴细胞、CD3+CD8+T淋巴细胞及Tregs参与卒中早期病理生理过 程，其动态变化可能导致卒中后免疫抑制，并参与卒中后感染的发生。

The Dynamic Changes of T Lymphocyte Subsets in Peripheral Blood in Patients with Stroke and Their Influence on Infection after Stroke

Objective To observe the dynamic changes of CD3+T cells, CD3+CD4+T cells, CD3+CD8+T cells and CD4+CD25+FoxP3+ regulatory T cells (Tregs) in peripheral blood of patients with acute stroke, and explore the immune state and its influence on infection after stroke. Methods There were 32 acute stroke patients in stroke group, and 23 age- and gender-matched healthy ones in control group. According to infection occurring within 1 week after stroke or not, 32 stroke patients were divided into infection group (n=8) and non-infection group (n=24). The levels of CD3+T cells, CD3+CD4+T cells, CD3+CD8+T cells and Tregs were determined serially on day 1, 3 and 7 after stroke onset in 32 stroke patients and 23 controls. Results ①Comparing with the control group, CD3+CD4+T cells and Tregs increased on day 7 after onset (P=0.02 and 0.03, respectively), CD3+CD8+T cells decreased on day 1 and 3 after onset (P=0.01 and 0.03, respectively) and restored to a normal level on day 7 in non-infection group. A significant fall of CD3+T cells, CD3+CD4+T cells, CD3+CD8+T cells and Tregs were observed on day 1 (P<0.001,<0.001, 0.03 and <0.001, respectively), 3 (P<0.001), and 7 (P<0.001, 0.01, 0.01 and 0.01, respectively) after onset in infection group. ②Comparing with non-infection group, CD3+T cells, CD3+CD4+T cells, and Tregs were all significantly lower on day 1 (P=0.01, <0.001 and <0.001, respectively), 3 (P<0.001,<0.001 and 0.04, respectively) and 7 (P<0.001) after onset in infection group. There was no significant difference in CD3+CD8+T cells between the two stroke groups on day 1, while this type of T cells in infection group significantly decreased on day 3 (P<0.001) and 7 (P=0.02) after onset than that of in non-infection group. Conclusion CD3+T cells, CD3+CD4+T cells, CD3+CD8+T cells and Tregs may involve in pathophysiological process in the acute phase of stroke. The dynamic changes of T lymphocytes may induce to immunodepression, and involve in infection after stroke.