血清 25(OH)D、Th17/Treg 失衡与新生儿 缺氧缺血性脑病预后的关系研究

Relationship between Serum 25(OH)D and Th17/Treg Imbalance and Prognosis of Neonatal Hypoxic-Ischemic Encephalopathy

摘要:

〔摘 要〕 目的：探究新生儿缺氧缺血性脑病（HIE）患儿血清 25– 羟基维生素 D〔25(OH)D〕及辅助性 T 细胞 17 （Th17）/ 调节性 T 细胞（Treg）与预后的关系。 方法：选取郑州市儿童医院 2019 年 1 月至 2021 年 1 月收治的 79 例 HIE 患儿作为观察组，后进行临床病情分度，其中中度 46 例，重度 33 例；另选取同时期郑州市儿童医院健康新生儿 79 例作为对照组。利用流式细胞术检测外周血中 Treg、Th17 并计算 Th17/Treg；采用酶联免疫吸附（ELISA）法检测 血清中 25(OH)D 水平。 结果：与对照组相比，观察组患儿血清中 Th17、Th17/Treg 较高，25(OH)D、Treg 较低，差异 具有统计学意义（P ＜ 0.05）；与 HIE 中度患儿相比，HIE 重度患儿血清中 Th17、Th17/Treg 较高，25(OH)D、Treg 较低，入院时、治疗 14 d 后的新生儿神经行为测定评分法（NBNA）评分均较低，差异具有统计学意义（P ＜ 0.05）； 对患儿随访 12 个月后，与神经发育正常组相比，神经发育不良组血清中 Th17、Th17/Treg 较高，25(OH)D、Treg 较低， 差异具有统计学意义（P ＜ 0.05）；与神经发育正常组相比，不良神经发育组入院时、治疗 14 d 后的 NBNA 评分较低， 差异具有统计学意义（P ＜ 0.05）。 结论： HIE 患儿血清 25(OH)D 呈低表达，Th17/Treg 存在免疫失衡，向 Th17 偏移， 25(OH)D 缺乏和 Th17/Treg 失衡可能导致 HIE 预后不良。

Abstract:

〔Abstract〕 Objective To explore the relationship between serum 25-hydroxyvitamin D [25(OH)D] and helper T cells 17 (Th17)/regulatory T cells (Treg) and prognosis in neonates with hypoxic-ischemic encephalopathy (HIE). Methods A total of 79 children with HIE admitted to Zhengzhou Children's Hospital from January 2019 to January 2021 were selected as the observation group, and clinical disease classification was performed, including 46 cases of moderate and 33 cases of severe. Another 79 healthy newborns in Zhengzhou Children's Hospital were selected as the control group. Treg and Th17 in peripheral blood were detected by flow cytometry and Th17/Treg was calculated. The level of 25(OH)D in serum was determined by enzyme-linked immunosorbent assay (ELISA). Results Compared with the control group, the serum levels of Th17 and Th17/Treg in the observation group were higher, and the levels of 25(OH)D and Treg were lower, the differences were statistically significant (P < 0.05). Compared with the children with moderate HIE, the serum levels of Th17 and Th17/Treg in the children with severe HIE were higher, and the levels of 25(OH)D and Treg were lower. The scores of neonatal neurobehavioral assay (NBNA) on admission and 14 days after treatment were lower, the differences were statistically significant (P < 0.05). After 12 months of follow-up, compared with normal neurodevelopment group, serum Th17 and Th17/Treg in poor neurodevelopment group were higher, and the levels of serum 25(OH)D and Treg were lower, with statistical significance (P < 0.05). Compared with the normal neurodevelopmental group, the poor neurodevelopmental group had a lower NBNA score at admission and 14 days after treatment, with statistical significance (P < 0.05). Conclusion The serum 25(OH)D expression is low in children with HIE, and Th17/Treg immune imbalance is present, which is shifted to Th17.25(OH)D deficiency and Th17/Treg imbalance may lead to poor prognosis in HIE.