Deng Gang, Tang Yue, Xiao Jun, Chen Xin, Chu Yun-Hui, Shang Ke, Zhou Luo-Qi, Qin Chuan, Wang Feng, Tian Dai-Shi
Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Aging Neurosci. 2023 Feb 23;15:1072980. doi: 10.3389/fnagi.2023.1072980. eCollection 2023.
Regulatory T cells (Treg) have been identified as a key modulator of neuroinflammation in stroke. However, little is known about the association of Treg subpopulations with clinical outcome in patients with acute ischemic stroke (AIS).
Patients within 1 week from stroke onset were prospectively enrolled in this study. Healthy controls were sex-and age-matched 1:1 to AIS patients. The frequencies of Treg and Treg subsets were analyzed by flow cytometry and compared with nonstroke control. Univariate and multivariate logistic regression analysis was performed to investigate the prognostic value of Treg subsets in stroke outcomes.
A total of 328 patients and 328 controls were included in the study. Compared with controls, patients with AIS had higher levels of Treg frequency and memory Treg (mTreg) frequency, but lower levels of naïve Treg (nTreg) frequency and nTreg/mTreg ratio. One hundred twenty-six (38.4%) patients experienced unfavorable outcome (modified Rankin score 2-6). Multivariate regression analysis showed that nTreg/mTreg ratio was negatively associated with unfavorable 90-day outcome (the highest tertile versus the lowest tertile: odds ratio 0.13, 95% confidential interval [CI] 0.05-0.35). The risk estimation of unfavorable 90 day outcome can be significantly improved by adding nTreg/mTreg ratio to the conventional clinical parameters (continuous net reclassification improvement 91.26, 95% CI 69.04-113.5%, < 0.001; integrated discrimination improvement 22.38, 95% CI 17.16-27.59%, < 0.001).
This study showed that patients with AIS had elevated Treg frequency and mTreg frequency, but reduced nTreg frequency and nTreg/mTreg ratio. Admission nTreg/mTreg ratio was an independent predictor of unfavorable 90 day outcome in AIS. However, large sample-size cohort studies are needed to confirm our findings.
调节性T细胞（Treg）已被确定为中风神经炎症的关键调节因子。然而，关于Treg亚群与急性缺血性中风（AIS）患者临床结局之间的关联，我们知之甚少。
前瞻性纳入中风发病1周内的患者。健康对照与AIS患者按1:1进行性别和年龄匹配。通过流式细胞术分析Treg及其亚群的频率，并与非中风对照进行比较。进行单因素和多因素逻辑回归分析，以研究Treg亚群对中风结局的预后价值。
本研究共纳入328例患者和328例对照。与对照相比，AIS患者的Treg频率和记忆性Treg（mTreg）频率较高，但初始Treg（nTreg）频率和nTreg/mTreg比值较低。126例（38.4%）患者预后不良（改良Rankin评分2 - 6分）。多因素回归分析显示，nTreg/mTreg比值与90天不良结局呈负相关（最高三分位数与最低三分位数相比：比值比0.13，95%置信区间[CI] 0.05 - 0.35）。将nTreg/mTreg比值添加到传统临床参数中，可显著改善90天不良结局的风险估计（连续净重新分类改善91.26，95% CI 69.04 - 113.5%，P < 0.001；综合判别改善22.38，95% CI 17.16 - 27.59%，P < 0.001）。
本研究表明，AIS患者的Treg频率和mTreg频率升高，但nTreg频率和nTreg/mTreg比值降低。入院时的nTreg/mTreg比值是AIS患者90天不良结局的独立预测因素。然而，需要大样本队列研究来证实我们的发现。
