| Objective:The improvement of the clinical score, the changes of the immunoglobulin, complement, peripheral blood mononuclear cells(PBMCs) and monocytes, the frequency of Th1, Th2, Th17, Treg cells in GBS patients before and after receiving LPE therapy were detected and compared. The influence of LPE on immune cells, especially CD4+T lymphocyte in GBS patients were discussed, further the relationship between these analyzed. So as to reveal the immune mechanism of LPE on the treatment of GBS and offer a theoretical guide for the therapeutic strategy of GBS.Methods:Hughes and MRC scores were performed before and after treatment in24cases of GBS patients, the blood routine, complete immunity and conventional blood coagulation before and after treatment were tested. PBMCs from12cases of GBS patients before and after receiving LPE therapy and12people physically healthy were taken, the frequency of Th1, Th2, Th17and Treg cells were detected by flow cytometry. The relationships among them were further analyzed. All statistics were dealed with SPSS17.0software package.Results:(1) After the treatment of LPE, the MRC scores on two days and one week was prominently improved as well as the Hughes scores. Four days after therapy, the MRC score was lower than that at two days after treatment, but the difference wasn’t statistically significant (P>0.05).(2) Compared with before LPE therapy, the serum levels of IgG, IgM, IgA,C3and C4in GBS patients after therapy was lower (respectively,7.38±3.62g/l vs8.92±4.05g/l;0.93±0.16g/l vs1.26±0.34g/l;2.03±0.51g/l vs2.57±0.55g/l;0.61±0.38g/l vs0.79±0.13g/l;0.13±0.02g/l vs0.17±0.03g/l), the difference were statistically significant (P<0.05).(3) Two days after LPE therapy, the proportion and numbers of PBMCs in GBS patients were lower than the before (respectively,30.57±5.26%vs39.94±6.83%;2.53±0.61×109/L vs3.31±0.55×109/L), the proportion and numbers of monocytes were lower than the before (respectively,5.34±0.71%vs8.72±0.54%;0.42±0.16×109/L vs0.65±0.17×109/L), the level of fibrinogen was lower than the before (2.42±0.75g/l vs3.96±1.01g/l), the difference were statistically significant (P<0.05).(4) Before LPE therapy, the frequency of Thl cells in GBS patients was higher than the NCs (29.23±7.56%vs16.84±5.73%), the difference were statistically significant (P<0.05); two days after therapy, the frequency of Thl cells (21.34±5.08%) was lower than the before but higher than the NCs, the difference were statistically significant (P<0.05); four days after therapy, the frequency of Th1cells (22.18±4.95%) was higher than the level at two days after treatment, but the difference wasn’t statistically significant (P>0.05).(5) Before LPE therapy, the frequency of Th2cells in GBS patients was lower than the NCs (3.27±1.73%vs5.08±1.87%), the difference were statistically significant (P<0.05); two days after therapy, the frequency of Th2cells (3.94±2.16%) was lower than the before, but the difference wasn’t statistically significant (P>0.05); four days after therapy, the frequency of Th2cells (3.72±1.35%) was higher than the level at two days after treatment, but the difference was not statistically significant (P>0.05). (6) Before LPE therapy, the Thl/Th2ratio in GBS patients was higher than the NCs (9.24±3.67vs3.31±1.04), the difference were statistically significant (P<0.05); two days after therapy, the Thl/Th2ratio (5.68±1.35) was lower than the before but higher than the NCs, the difference were statistically significant (P<0.05); four days after therapy, the Th1/Th2ratio (5.94±1.62) was higher than the level at two days after treatment, but the difference wasn’t statistically significant (P>0.05).(7) Before LPE therapy, the frequency of Th17cells in GBS patients was higher than the NCs (1.94±0.61%vs0.91±0.37%), the difference were statistically significant (P<0.05); two days after therapy, the frequency of Thl cells (1.13±0.28%) was lower than the before but higher than the NCs, the difference were statistically significant (P<0.05); four days after therapy, the frequency of Th17cells (1.25±0.49%) was higher than the level at two days after treatment, but the difference wasn’t statistically significant (P>0.05).(8) Before LPE therapy, the frequency of Treg cells in GBS patients was lower than the NCs (2.27±0.78%vs4.31±0.93%), the difference were statistically significant (P<0.05); two days after therapy, the frequency of Treg cells (3.34±0.65%) was lower than the before but higher than the NCs, the difference were statistically significant (P<0.05); four days after therapy, the frequency of Treg cells (3.02±0.62%) was higher than the level at two days after treatment, but the difference wasn’t statistically significant (P>0.05).(9) Before LPE therapy, the Th17/Treg ratio in GBS patients was higher than the NCs (0.89±0.37vs0.21±0.06), the difference were statistically significant (P<0.05); two days after therapy, the Th17/Treg ratio (0.38±0.12) was lower than the before but higher than the NCs, the difference were statistically significant (P<0.05); four days after therapy, the Th17/Treg ratio (0.43±0.15) was higher than the level at two days after treatment, but the difference wasn’t statistically significant (P>0.05).(10) Before LPE therapy, the frequency of Th1, Th17cells in GBS patients had negative correlation with MRC scores (respectively, r=0.745, r=-0.692, P<0.05); the frequency of Th2, Treg cells in GBS patients were significant correlated with MRC scores (respectively, r=0.561, r=-0.758, P<0.05); Th1/Th2and Th17/Treg ratio had negative correlation with MRC scores (respectively, r=-0.802, r=-0.764, P<0.05).(11) Two days after LPE therapy, the frequency of Th1, Th2, Th17, Treg cells and the levels of immunoglobulin, complement, fibrinogen, PBMCs and mononuclear cells in GBS patients were not correlated with the MRC scores.(12) Two days after LPE therapy, the improvement of MRC scores in GBS patients were significant correlated with the declines of Th1, Th17, Th1/Th2ratio, Th17/Treg ratio (respectively, r=0.653, r=0.721, r=0.682, r=0.796). And the improvement of MRC scores in GBS patients were significant correlated with the increase of Treg cells (r=0.786, P<0.05). The increase of Th2cells was not significant correlated with the improvement of MRC scores.Conclusions:(1) LPE treatment significantly improve Hughes and MRC scores of patients with GBS.(2) By correcting the disorder of Th1/Th2and Th17/Treg, and the direct removal of immunoglobulin, complement, mononuclear cells, fibrinogen and other pathological substances, LPE play its therapeutic effect on GBS. |
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