血清25-羟基维生素D、Th17Treg细胞失衡与新生儿缺氧缺血性脑病预后的相关性研究.docx

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1、血清25-羟基维生素D、Th17Treg细胞失衡与新生儿缺氧缺血性脑病预后的相关性研究屈菊梅，张龙，刘荣*陕西省延安市人民医院新生儿科，陕西延安716000摘要：目的探究缺氧缺血性脑病(H1E)患儿血清25-羟基维生素D(25(OH)D)及Th17Treg细胞的水平，并分析25(OH)D及Th17Treg细胞与预后关系:方法选取2019年1月-2023年1月本院收治的HIE患儿79例为研究对象(H1E组)，对H1E患儿进行临床分度，分为中度46例，重度33例；选取同时期本院健康新生儿79例为对照组。利用流式细胞术检测外周血中Treg细胞比率、Th17细胞比率并计算Th1Th17细胞比率；采用酶

2、联免疫吸附(E1ISA)法检测血清中25(0H)D、白细胞介素(I1)-17和I1-23及I1-Io和转化生长因子-(TGF-)水平。根据随访的H1E患儿神经发育情况，分为神经发育正常组52例和不良神经发育组27例。采用COX法分析影响HIE患儿预后不良的因素,结果与对照组相比，HIE组血清中I1-17(62.196.48)ng/1vs(38.084.37)ng1I1-23(23.103.55)ng/1vs(12.852.46)ng/1水平、ThI7细胞的比率(3.940.89)%vs(1.97O.35)%及Th17/Treg细胞的比率(0.580.16)vs(0.16().08)较高(/=2

3、7.418、21.094、18.309、20.868,P均=0.000)，25(OH)D(29.146.02)ng/m1vs(45.379.07)ngm1.I1-IO(46.816.88)ng/1vs(63.459.16)ng/1、TGF-水平(27.193.95)ng/1vs(37.754.82)ng/1、Treg细胞的比率(6.211.15)%vs(8.951.46)%较低(日3.251、12.910、15.06K13.104,P均=0.0(X)；与中度组相比,重度组血清中I1-17(71.037.40)ng/1vs(55.845.82)ng/1、I1-23(29.834.75)ng/1v

4、s(18.272.81)ng/1水平、ThI7细胞的比率(4.891.1I)%vs(3.260.74)%及7/Treg细胞的比率(0.890.24)vs(O.35O.1O)较高(/=10.207、12.189、7.833、13.716,P均=0.000),25(OH)D(20.594.25)ng/m1vs(35.277.29)ng/m1,I1-IO(39.165.75)ng/1vs(52.297.69)ng/1、TGF-B水平(22.673.30)ng/1vs(30.434.22)ng/1、Treg细胞的比率(4.530.84)%vs(7.421.37)%较低(/=10.362,8.282、8

5、.803、10.745,P均=O.(XX);与中度组相比，HIE重度组入院时、治疗14d后的NBNA评分(25.61191)分VS(27.841.86)分、(34.081.16)分VS(36.62+1.24)分较低(/=6.050、9.222,P均=0.000)。与神经发育正常组相比，不良神经发育组入院时、治疗14d后的NBNA(2527188)分VS(27.761.85)分、(32.5O1.11)分VS(37.151.26)分评分较低(/=5.643、16.182,P侬0.000):与神经发育正常组相比，不良神经发育组血清中I1-17(84.048.76)ng/1vs(50.845.30)n

6、g/1、I1-23(35.445.37)ng/1vs(I6.692.57)ng/1水平、Th17细胞的比率(5.331.21)%vs(3.220.73)%及Th17/Treg细胞的比率(1.130.31)VS(0.290.08)较高(/=20.977X21.042、9.663、18.488,P均=0.000),25(OH)D(13.492.79)ng/m1vs(37.267.69)ng/m1、I1-IO(29.624.36)ng/1vs(55.738.19)ng/1、TGF-水平(22.93333)ng/1vs(39.935.80)ng/1、Treg细胞的比率(3.58O.67)%vs(7.5

7、81.41)%较低(/=15.500、15.437、14.048、13.916,P均=0.0)。多因素CoX分析显示，低水平25(0H)D、Th17/Treg细胞失衡是影响H1E患儿不良预后的危险因素(HR=2.459,HR=2.425,P0.05)结论HIE患儿血清25(0H)D呈低表达，外周血单个核细胞Th17rreg细胞存在免疫失衡，25(0H)D缺乏和Th17/Treg细胞失衡可能影响HIE预后不良发生I1关键词,新生儿缺氧缺血性脑病：25-羟基维生素D；ThI7/Treg细胞中图分类号：R722.1文献标志码：ARe1ationshipbetweenserum25-hydroxyvi

8、taminD,Th17/Tregce11imba1anceandprognosisofneonata1hypoxicischemicencepha1opathyQUJu-mei,ZHANG1ong.1IURong*DepartmentofNeonato1ogy,YananPeop1esHospita1.Shaafixi76000,ChinaAbstract:ObjectiveToinvestigatethe1eve1sof25-hydroxyvitaminD25(OH)DinserumandTh17/Tregce11sinchi1drenwithhypoxic-ischemicencepha1

9、opathy(HIE),andtoana1yzethere1ationshipbetween25(OH)D.Th17/Tregce11sandprognosis.MethodsAtota1of79casesofHIEinourhospita1fromJanuary2019toJanuary2023werese1ectedastheresearchobjects(HIEgroup),accordingtothec1inica1c1assificationofHIEchi1dren,theyweredividedintomoderate46casesandsevere33cases;79cases

10、ofhea1thynewbornsinourhospita1atthesametimewerese1ectedasthecontro1group.TheratiosofTregce11sandTh17ce11sinperiphera1b1oodweredetectedbyf1owcytometry,andtheratioofTh1ZTh17ce11swasca1cu1ated;the1eve1sof25(OH)D,Inter1eukin(I1)-17,I1-23,I1-10andtransforminggrowthfoctor-(TGF-)inserumweredetectedbyenzyme

11、-1inkedimmunosorbentassay(E1ISA).Accordingtothefb11ow-upneurodeve1opmenta1statusofHIEchi1dren.H1Echi1drenweredividedintoneurodeVe1opmenta1Iynorma1group(52cases)andadverseneurodeve1opmenta1group(27cases).COXmethodwasusedtoana1yzethefactorsaffectingtheprognosisofHIEchi1dren.Resu1tsComparedwiththoseint

12、hecontro1group,the1eve1sofI1-17(62.196.48)ng/1vs(38.084.37)ng1andI1-23(23.10+3.55)ng/1vs(12.852.46)ng1inserum,theratioofTh17ce11s(3.940.89)%vs(1.970.35)%andtheratioofTh17Tregce11s(0.580.16)vs(0.160.08)inHIEgroupwerehigher(r=27.418,21.094,18.309,20.868,a11P=0.000).whi1ethe1eve1sof25(OH)D(29.146.02)ng

13、/m1vs(45.37+9.07)ngm1,I1-10(46.816.88)ng/1vs(63.45+9.16)ng/1,TGF-(27.193.95)ng/1vs(37.754.82)ng/1JinserumandtheratioofTregce11s(6.211.15)%vs(8.951.46)%were1ower(r=13.251,12.910,15.061,13.104,a11P=0.000);comparedwiththoseinthemoderategroup,the1eve1sofI1-17(71.037.40)ng/1vs(55.845.82)ng/1JandI1-23(29.

14、834.75)ng/1vs(18.272.81)ng/1inserum,theratioofTh17ce11sI(4.891.11)%vs(3.260.74)%andtheratioofTh17Tregce11s(0.890.24)vs(0.350.10)Jintheseveregroupwere1ower(/=10.207,12.189,7.833,13.716,a11P=0.000),whi1ethe1eve1sof25(OH)D1(20.59+4.25)ng/m1vs(35.277.29)ngm1,I1-10(39.165.75)ng/1vs(52.297.69)ng1,TGF-(22.

15、67+3.30)ng/1vs(30.43+4.22)ng/1inserumandtheratioofTregce11s(4.530.84)%vs(7.421.37)%werehigher(/=10.362,8.282,8.803,10.745,a11P=0.000);comparedwiththemoderategroup,theNBNAscoreofthesevereHIEgroupatadmission(25.611.91)scorevs(27.84+1.86)scoreand14daysaftertreatment(34.081.16)scorevs(36.621.24)scorewas1ower(t=6.050.9.222,a11P=0.000).Comparedwiththenorma1neurodeve1opmentgroup,thepoorneurodeve1opmentgrouphad1owerNBNAscoresonadmission(25.271.88)scorevs(27.761.85)scoreand14daysaftertreatment(32.501.1I)scorevs(37.151.26)score(/=5.643,16.182,a11P=0.000);comparedwitht