缺血性脑卒中后抑郁患者外周血CDC42、Th17细胞表达及与抑郁程度的相关性分析

Expression of CDC42 and Th17 cells in peripheral blood of patients with post ischemic stroke depression and their correlation with the degree of depression

摘要:

目的 观察缺血性脑卒中患者外周血细胞分裂周期蛋白42（CDC42）、辅助性T细胞17（Th17）表达并探究其表达与患者抑郁程度的相关性。方法 选取2022年1月—2023年1月河北北方学院附属第一医院收治的200例缺血性脑卒中患者为观察组，另选取同期该院200例体检健康者为对照组。患者入院后均接受常规抗血小板聚集、降脂等对症支持治疗，并采用多感官刺激方案对患者进行干预。采用蒙哥马利抑郁评定量表评估患者的抑郁状态，并将患者分为无抑郁组116例、轻度抑郁组38例、中度抑郁组31例、重度抑郁组15例。比较各组医院焦虑抑郁量表（HADS）和简易精神状态评价量表（MMSE）评分，比较观察组干预前后日常生活活动能力（ADL）评分；检测各组外周血CDC42 mRNA、Th17细胞、调节性T细胞（Treg）、Th17/Treg表达。以Pearson相关系数分析HADS评分与患者外周血CDC42 mRNA、Th17细胞、Treg细胞、Th17/Treg表达水平的相关性。结果 观察组HADS-A评分、HADS-D评分均高于对照组（P <0.05），MMSE评分低于对照组（P <0.05）。重度抑郁组HADS-A评分、HADS-D评分高于其他组（P <0.05），MMSE评分低于其他组（P <0.05）；中度抑郁组HADS-A评分、HADS-D评分高于轻度抑郁组和无抑郁组（P <0.05），MMSE评分低于轻度抑郁组和无抑郁组（P <0.05）；轻度抑郁组HADS-A评分、HADS-D评分高于无抑郁组（P <0.05），MMSE评分低于无抑郁组（P <0.05）。观察组外周血CDC42 mRNA、Treg细胞的表达水平低于对照组（P <0.05），外周血Th17细胞、Th17/Treg的表达水平高于对照组（P <0.05）。重度抑郁组Th17细胞、Th17/Treg表达水平高于其他组（P <0.05），Treg细胞表达水平低于另外组（P <0.05），中度抑郁组Th17细胞、Th17/Treg表达水平高于轻度抑郁组、无抑郁组（P <0.05），Treg细胞表达水平低于轻度抑郁组、无抑郁组（P <0.05），轻度抑郁组Th17细胞、Th17/Treg表达水平高于无抑郁组（P <0.05），Treg细胞表达水平低于无抑郁组（P <0.05）。观察组干预后HADS-A评分、HADS-D评分低于干预前（P <0.05），MMSE评分、ADL评分高于干预前（P <0.05）。观察组干预前后外周血CDC42 mRNA表达水平比较，差异无统计学意义（P >0.05）。观察组干预后外周血Th17细胞、Th17/Treg表达水平低于干预前（P <0.05），外周血Treg细胞表达水平高于干预前（P <0.05）。观察组患者外周血Th17细胞、Th17/Treg表达与HADS评分呈正相关（r =0.673、0.603，均P <0.05），外周血Treg细胞表达与HADS评分呈负相关（r =-0.586，P <0.05），外周血CDC42 mRNA与HADS评分无相关性（r =-0.375，P >0.05）。结论 缺血性脑卒中患者外周血CDC42 mRNA表达明显降低、Th17细胞表达明显升高，随着患者抑郁程度加重，Th17细胞表达逐渐升高，而CDC42 mRNA表达与患者的抑郁程度无相关性，可通过合理的干预措施减轻抑郁情绪，防止病情加重。

Abstract:

Objective To observe the expression of peripheral blood cell division cycle protein 42 (CDC42) and helper T cell 17 (Th17) in patients with ischemic stroke and explore their correlation with the degree of depression in patients.Methods From January 2022 to January 2023, 200 patients with ischemic stroke admitted to the First Affiliated Hospital of Hebei North University were selected as the observation group, and 200 healthy individuals undergoing physical examinations during the same period were selected as the control group. After admission, all patients received routine antiplatelet aggregation, lipid-lowering, and symptomatic supportive treatment, and a multimodal sensory stimulation program was used for intervention. The Montgomery Depression Rating Scale was used to assess the depressive state of the patients, and the patients were divided into the non-depression group (116 cases), mild depression group (38 cases), moderate depression group (31 cases), and severe depression group (15 cases). The HADS and MMSE scores of each group were compared, and the daily life activity (ADL) score before and after intervention in the observation group was compared. The expression of peripheral blood CDC42 mRNA, Th17 cells, regulatory T cells (Treg), and Th17/Treg in each group was detected. The correlation between HADS scores and the expression levels of CDC42 mRNA, Th17 cells, Treg cells, and Th17/Treg in peripheral blood was analyzed using Pearson correlation coefficient.Results The HADS-A and HADS-D scores in the observation group were higher than those in the control group (P < 0.05), and the MMSE score was lower than that in the control group (P < 0.05). The HADS-A and HADS-D scores in the severe depression group were higher than those in the other groups (P < 0.05), and the MMSE score was lower than that in the other groups (P < 0.05). The HADS-A and HADS-D scores in the moderate depression group were higher than those in the mild depression group and non-depression group (P < 0.05), and the MMSE score was lower than that in the mild depression group and non-depression group (P < 0.05). The HADS-A and HADS-D scores in the mild depression group were higher than those in the non-depression group (P < 0.05), and the MMSE score was lower than that in the non-depression group (P < 0.05). The expression levels of peripheral blood CDC42 mRNA and Treg cells in the observation group were lower than those in the control group (P < 0.05), and the expression levels of peripheral blood Th17 cells and Th17/Treg were higher than those in the control group (P < 0.05). The expression levels of Th17 cells and Th17/Treg in the severe depression group were higher than those in the other groups (P < 0.05), and the expression level of Treg cells was lower than that in the other groups (P < 0.05). The expression levels of Th17 cells and Th17/Treg in the moderate depression group were higher than those in the mild depression group and non-depression group (P < 0.05), and the expression level of Treg cells was lower than that in the mild depression group and non-depression group (P < 0.05). The expression levels of Th17 cells and Th17/Treg in the mild depression group were higher than those in the non-depression group (P < 0.05), and the expression level of Treg cells was lower than that in the non-depression group (P < 0.05). After intervention, the HADS-A and HADS-D scores in the observation group were lower than those before intervention (P < 0.05), and the MMSE and ADL scores were higher than those before intervention (P < 0.05). There was no significant difference in the expression level of peripheral blood CDC42 mRNA before and after intervention in the observation group (P > 0.05). After intervention, the expression levels of peripheral blood Th17 cells and Th17/Treg in the observation group were lower than those before intervention (P < 0.05), and the expression level of peripheral blood Treg cells was higher than that before intervention (P < 0.05). The expression levels of peripheral blood Th17 cells and Th17/Treg in the observation group were positively correlated with HADS scores (r = 0.673 and 0.603, both P < 0.05), and the expression level of peripheral blood Treg cells was negatively correlated with HADS scores (r = -0.586, P < 0.05). There was no correlation between peripheral blood CDC42 mRNA and HADS scores (r = -0.375, P > 0.05).Conclusion The expression of peripheral blood CDC42 mRNA in patients with ischemic stroke is significantly reduced, and the expression of Th17 cells is significantly increased. With the aggravation of the patient's depressive state, the expression of Th17 cells gradually increases, while the expression of CDC42 mRNA is not significantly correlated with the patient's degree of depression. Reasonable interventions can alleviate depressive emotions and prevent the worsening of the condition.