Abstract:

Objective To observe the dynamic changes of T lymphocyte subsets in peripheral blood of patients with hypertensive intracerebral hemorrhage, and to explore the immunosuppression state after hypertensive intracerebral hemorrhage. Methods This prospective study included 30 patients with mild (GCS 12-15 points), moderate (GCS 9-11) and severe (GCS 3-8 points) hypertensive cerebral hemorrhage according to the GCS score at admission. 30 patients with essential hypertension without cerebral hemorrhage were selected as the controls. Venous blood was collected on day1, 3, 7, 14 and 28 after intracerebral hemorrhage in hypertensive intracerebral hemorrhage group and on the second day of hospitalization in the control group, to detect the proportion of peripheral blood CD4+ and CD8+ lymphocytes and calculate the CD4+/CD8+ ratio, and analyze the trend of changes in the levels of CD4+ and CD8+ T lymphocytes in patients with hypertensive cerebral hemorrhage. Results In the differences of the groups, the proportion of CD4+ and CD8+ lymphocytes in the mild, medium, and severe hypertensive intracerebral hemorrhage subgroups were all lower than that in control group on day 1, 3, and 7; the proportion of CD4+ and CD8+ only in severe subgroup on day 14 were lower than that in control group; there was no statistical difference in the proportion of CD4+and CD8+ cells among the 4 subgroups on day 28. In the changes trend, the proportion of CD4+ and CD8+ lymphocytes in all the hypertensive cerebral hemorrhage patients showed a trend of first decreasing and then increasing after onset. The proportion of CD4+ lymphocytes was lowest on day 3, and then gradually increased; the proportion of CD8+ lymphocytes was the lowest on day 1, then gradually increased, and basically rose to the level of control group on day 28. Conclusions The percentage of T-lymphocytes (CD4+, CD8+) all decreased firstly and then returned to normal level after cerebral hemorrhage. In the early stage (within 7 days after onset), the level of immune cells was significantly lower than the normal level, indicating that the immune function is in suppression state. The immune cells level basically returned to normal level on day14 after cerebral hemorrhage in mild and moderate hypertensive intracerebral hemorrhage patients, while that returned to normal level on day 28 in severe patients.

Key words: Hypertension; Cerebral hemorrhage; T lymphocyte subset; Immunologic function

摘要：

目的 观察高血压脑出血患者外周血T淋巴细胞亚群水平动态变化，探讨高血压脑出血后免疫抑制 情况。 方法 本研究为前瞻性研究，根据入院时GCS评分纳入轻型（GCS 12～15分）、中型（GCS 9～11分） 和重型（GCS 3～8分）高血压脑出血患者各30例。另外纳入无脑出血的原发性高血压患者30例为对 照组。高血压脑出血患者于发病后1 d、3 d、7 d、14 d和28 d，对照组于住院第二日采集静脉血检测外 周血CD4+、CD8+淋巴细胞比例，并计算CD4+/CD8+比值，分析高血压脑出血患者T淋巴细胞CD4+和 CD8+亚群水平的变化趋势。 结果 组间比较结果显示，高血压脑出血轻型组、中型组、重型组CD4+和CD8+淋巴细胞比例在发 病1 d、3 d、7 d时均低于对照组，14 d时仅重型组的CD4+和CD8+淋巴细胞比例低于对照组，28 d时四 组CD4+和CD8+淋巴细胞比例差异均无统计学意义。从时间变化趋势分析，不同严重程度的高血压 脑出血患者CD4+和CD8+淋巴细胞比例均呈发病后先降低再升高的趋势，其中CD4+淋巴细胞比例在 3 d时最低，后逐渐升高，CD8+淋巴细胞比例在1 d时最低，后有所波动，但呈逐渐升高趋势，28 d时基 本升高至对照组水平。 结论 高血压脑出血后患者T淋巴细胞（CD4+、CD8+）比例均呈现先降低再升高的趋势。在发病早 期（7 d内），免疫细胞水平低于正常水平，提示免疫功能处于抑制状态，轻型和中型组在发病14 d时 免疫细胞水平基本接近正常，而重型组在发病28 d后免疫细胞水平才基本接近正常。

关键词: 高血压; 脑出血; T淋巴细胞亚群; 免疫功能