摘要：

目的 探讨颈动脉粥样硬化性缺血性卒中患者外周血辅助性T 细胞1、2 和17（Th1、Th2 和Th17）的分布特点。方法 共180 例颈动脉粥样硬化性缺血性卒中患者，根据颈动脉狭窄程度分为颈动脉轻度狭窄亚组、中度狭窄亚组和重度狭窄亚组（各60 例），流式细胞术检测患者外周血Th1、Th2 和Th17 细胞比例。结果 缺血性卒中组患者外周血Th1 和Th17 细胞比例均高于对照组［（5.76 ± 1.81）%对（3.54 ± 0.29）%，P = 0.000；（0.36 ± 0.13）%对（0.18 ± 0.03）%，P = 0.000］。颈动脉狭窄不同程度亚组患者外周血Th1［（4.56 ± 0.55）%、（4.88 ± 0.42）%和（7.83 ± 1.69）%，P = 0.000］和Th17［（0.23 ± 0.04）%、（0.34 ± 0.02）%和（0.50 ± 0.09）%，P = 0.000］细胞比例差异均有统计学意义，其中，重度狭窄亚组Th1（P = 0.001，0.001）和Th17（P = 0.000，0.001）细胞比例高于轻度狭窄亚组和中度狭窄亚组，中度狭窄亚组仅Th17 细胞比例高于轻度狭窄亚组（P = 0.000）。结论 Th1 和Th17 细胞与颈动脉粥样硬化狭窄程度密切相关，随着颈动脉狭窄程度的加重，外周血Th17 细胞比例升高，表明细胞免疫机制参与颈动脉粥样硬化的发生与发展，为颈动脉粥样硬化性缺血性卒中的免疫治疗提供理论依据。

关键词: 动脉粥样硬化, 卒中, 脑缺血, Th1细胞, Th2细胞, 流式细胞术

Abstract:

Objective To investigate the distribution of T helper cell 1 (Th1), Th2 and Th17 in peripheral blood of patients with carotid atherosclerotic ischemic stroke.  Methods There were a total of 180 patients with carotid atherosclerotic ischemic stroke and 60 normal controls enrolled in this study. According to the degree of carotid artery stenosis, 180 patients were divided into 3 subgroups: mild stenosis group (N = 60), moderate stenosis group (N = 60) and severe stenosis group (N = 60). Flow cytometry (FCM) was used to test the proportion of Th1, Th2 and Th17 cells in peripheral blood.  Results  Compared with control group, the proportion of Th1 [(5.76 ± 1.81)% vs (3.54 ± 0.29)%, P = 0.000] and Th17 [(0.36 ± 0.13)% vs (0.18 ± 0.03)% , P = 0.000] cells in ischemic stroke group was significantly increased. There were statistical differences in the proportion of Th1 cells [(4.56 ± 0.55)%, (4.88 ± 0.42)% and (7.83 ± 1.69)%; P = 0.000] and Th17 cells [(0.23 ± 0.04)%, (0.34 ± 0.02)% and (0.50 ± 0.09)%; P = 0.000] in peripheral blood of patients with different degrees of carotid stenosis. The proportion of Th1 cells (P = 0.001, 0.001) and Th17 cells (P = 0.000, 0.001) in severe stenosis group were higher than those in mild and moderate stenosis groups, and the proportion of Th17 cells was higher in moderate stenosis group than that in mild stenosis group (P = 0.000).  Conclusions  Th1 and Th17 cells participate in the pathological process of carotid atherosclerosis. As the degree of carotid atherosclerosis in patients with ischemic stroke is increased, the proportion of peripheral blood Th17 cells is increased, suggesting that cellular immune mechanism is involved in the occurrence and development of atherosclerosis and provide theoretical basis for the immune treatment of carotid atherosclerotic ischemic stroke.

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