标题：老年男性心功能不全患者外周血CD4+和CD8+调节T细胞的变化及免疫调节的干预作用

      作者：韩丽娜 1，林晓明 2，臧传波 1，李 靖 1，杨立明 1，丁国雷 1，彭 锦 2
    （1.中国人民解放军总医院海南分院保健科，海南 三亚 572014；
2.中国人民解放军第187中心医院心内科，海南 海口 571159）

      卷次： 2013年24卷19期

      【摘要】 目的 探讨T淋巴细胞亚群CD4+调节细胞（CD4+CD25+Treg）和CD8+调节细胞（CD8+CD28-Treg）在老年
男性慢性心功能不全患者外周血中的变化，以及免疫调节治疗对其的影响。方法 155例老年男性，114例诊断
为慢性心功能不全（CCI），41例为心功能正常者。所有患者均行超声心动图检测，并采集外周血。分离外周血T
淋巴细胞，采用流式细胞学检测技术测定CD4+CD25+Treg和CD8+CD28-Treg亚群分布。非均相免疫法检测血浆N末
端脑利钠肽前体（NT-proBNP）水平，免疫比浊法检测C反应蛋白（CRP）。参与者分成三组，第一组是正常对照组
(n=41)，第二组是CCI干预组(n=60)，接受常规抗心功能不全和胸腺五肽治疗(20 mg，肌肉注射，隔日1次，共3个
月)，第三组是CCI对照组（n=54），只给予常规抗心功能不全治疗。结果 与对照组相比，CCI两组左室射血分数
（LVEF）、CD4+CD25+Treg和CD8+CD28-Treg亚群水平下降；而左室舒张末期内径（LVEDD）、NT-proBNP和CRP水平
升高。NT-proBNP和CRP水平同LVEF呈负相关，CD4+CD25+Treg和CD8+CD28-Treg水平同LVEF呈正相关。而
CCI干预组较CCI对照组能更好地升高CD4+CD25+Treg和CD8+CD28-reg亚群水平而改善心功能。结论 CD4+CD25+
Treg和CD8+CD28-Treg水平变化提示其在CCI过程中发挥重要作用，CD4+和CD8+调节T细胞变化可能是治疗CCI
的重要方向之一。

      【关键词】 慢性心功能不全；免疫；老年；CD4+CD25+Treg；CD8+CD28-Treg

      【中图分类号】 R541 【文献标识码】 A 【文章编号】 1003—6350（2013）19—2866—07


Analysis of change in percentage of CD4+ and CD8+ Treg in peripheral blood in aged male patients with chronic
cardiac insufficiency.
HAN Li-na 1, LIN Xiao-ming 2, ZANG Chuan-bo 2, LI Jing 1, YANG Li-ming 1, DING Guo-lei 1,
PENG Jin 2. 1. Department of Health Care, Hainan Branch Chinese PLA General Hospital, Sanya 572014, Hainan,
CHINA; 2. Department of Cardiology, the 187th Central Hospital of Chinese PLA, Haikou 571159, Hainan, CHINA

【Abstract】 Objective To investigate the change in percentage of CD4+CD25+ Treg and CD8+CD28- Treg in pe-
ripheral blood in aged male patients with chronic cardiac insufficiency (CCI). Methods The participants were 155 el-
derly men, among whom 114 were diagnosed as CCI and 41 had normal heart function. All patients underwent echo-
cardiography examination and had their peripheral blood collected. T lymphocytes in peripheral blood were separated
and determined distribution of CD4+CD25+ Treg and CD8+CD28- Treg using flow cytometry. Serum N terminal pro-brain
natriuretic peptide (NT-proBNP) levels were detected by heterogeneous immunoassay. C reactive protein (CRP) was
detected by immunoturbidimetry assay. Participants were divided into three groups: the CCI intervention group (re-
ceived regular therapy and thymopendin, 20 mg intramuscular injection, once every other day for 3 months, n=60), the
CCI control group (received regular therapy, n=54), and the control group (n=41). Results In comparison to the con-
trol group, levels of left ventricular ejection fraction (LVEF), CD4+CD25+ Treg and CD8+CD28- Treg decreased in CCI in-
tervention group and CCI control group, while levels of left ventricular end diastolic diameter (LVEDD), NT-proBNP
and CRP increased. Levels of NT-proBNP and CRP were negatively correlated with LVEF, while levels of CD4+CD25+
Treg and CD8+CD28- Treg showed positive correlation with LVEF. LVEF could be much improved via increasing distri-
bution of CD4+CD25+ Treg and CD8+CD28- Treg in CCI intervention group than in CCI control group. Conclusion The
abnormal distribution of CD4+CD25+ Treg and CD8+CD28- Treg suggestes that they play an important role in the develop-
ment of CCI. Modulation of these T lymphocytes subsets might be a strategy to treat CCI.

      【Key words】 Chronic cardiac insufficiency; Immunity; Aged; CD4+CD25+ Treg; CD8+CD28- Treg