The Study On The Relationship Between The Immune Inflammatory Response Regulated By Th17/Treg After Stroke And The Occuring Of Depression

BackgroundPost-stroke depression(PSD)is one affective disorder after cerebral stroke,often accompanied by damage of cognitive function,depression and loss of one’s interest or pleasure are major characteristics of it.The interaction between depression and cognitive dysfunction greatly delays the recovery of neurological function and the improvement of quality life.Immune inflammatory response after stroke throughout the entire physiological stage of recovery after stroke,Th17 cells and Treg cells play a critical role in this progress,directly affect the damage and repair of CNS,is correlating with complication of depression,cognitive dysfunction and prognosis.ObjectivesAnalyze the differences of the CD4+T cells Th17,Treg cells level and Th17/Treg ratio between the patients of Post-stroke depression and stroke alone,exploring their relationship with PSD.Methods1.The diagnostic of cerebral infarction meet the fourth cerebrovascular disease of the Chinese Medical Association Conference cerebral hemorrhage cerebral infarction diagnostic criteria,and confirmed by head CT or MRI scan.Collecting the clinical data once the research objects were included,various detection and evaluation will be operatedin the acute phase of stroke and 3 months after stroke.Grouping principle : Mental symptoms at the 3 months after stroke meet the DSM-V Depression diagnostic criteria,and the 17-item Hamilton≥8 score will be regarded as PSD group,otherwise will be perceived as Stroke group.2.In the acute stage of cerebral infarction: the neurological function will be evaluated by the National Institutes of Health Stroke Scale(NIHSS),the ability of daily life will be assessed using Brathal index(BI).In the acute phase of cerebral infarction and 3 months after stroke: Evaluating the cognitive function by the mini mental state examination(MMSE)and Montreal cognitive assessment scale(MoCA).3.Detecting the peripheral blood CD4+T cells Th17 and Treg cells level by flow cytometry(FCM)and related cytokines such as IL-17 A,IL-6 and IL-10 using Cytometric Bead Array(CBA)of the acute cerebral ischemic stroke and 3 months after stroke.Results1.Contrast of clinical features: compared with the stroke group,the PSD group is tend to receive a lower degree of education,the difference has statistical significant(P<0.05);The PSD group has a higher female proportion,the difference has statistical significant when compare with the stroke group(P<0.05);As for the NIHSS and BI score at the acute period,The PSD group is likely to achieve a higher NIHSS score but a lower BI score,the differences have statistical significant compared with the stroke group(P<0.05).The differences of age and complication such as hypertension and diabetes mellitus between the two groups have no statistical significant(P>0.05).2.According to the Cognitive evaluation results: At the time of 3 months follow-up:the MMSE and MOCA score of the PSD group are lower compared with the stroke the group,the differences have statistical significant(P<0.05);Furthermore the score of the stroke group is higher than they acquired at the acute period,the difference has statistical significant(P<0.05);while the score of the PSD group is certain degree higher than they acquired at the acute period,the difference has no statistical significant(P>0.05).3.Flow cytometry tests revealed: At the time of 3 months after stroke: the peripheral blood Th17 ratio and Th17/Treg specific value of the PSD group is higher than the stroke group,the differences have statistical significant(P<0.05);while the differences of the Treg ratio between the two groups has no statistical significant(P>0.05).Nevertheless,the three indexes between the two groups at the acute phase shows no significant differences(P>0.05).4.Cytometric Bead Array detection comparison: At the time of 3 months after stroke:the cytokine IL-17 A concentration of the PSD group is higher than the stroke group,the difference has statistical significant(P<0.05);while the differences of the IL-10 and IL-6 concentration between the two groups has no statistical significant(P>0.05).Nevertheless,the two indexes between the two groups at the acute phase shows no significant differences(P>0.05).ConclusionsThe imbalance of Th17/Treg ratio in the Stroke rehalitation stage(at the 3 months after stroke)is related to the occurring of Depression.