摘要
目的 观察不同预后重症脓毒症患者外周血单核细胞Toll样受体4（TLR4）的表达与内毒素耐受之间的关系.方法 选取35例重症脓毒症患者（重症脓毒症组）和15例健康体检者（对照组）,分别在入住ICU 24 h内和体检当天用流式细胞术测定外周血单核细胞TLR4表达情况及酶联免疫吸附法测定血清肿瘤坏死因子（TNF）-α、白细胞介素（IL）-10浓度.同时分离外周血单核细胞,加入40 μg/ml脂多糖培养24h,同样测定单核细胞TLR4表达情况及细胞培养上清液TNF-α、IL-10浓度.结果 35例重症脓毒症患者死亡10例（死亡组）,生存25例（生存组）,28 d病死率为28.6％（10/35）.重症脓毒症组外周血单核细胞TLR4表达显著低于对照组[（11.09±8.90）平均荧光强度（MFI）比（33.72±12.59） MFI],差异有统计学意义（P＜0.01）；血清TNF-α、IL-10浓度显著高于对照组[（96.66±45.33） ng/L 比（2.53±1.21） ng/L、（149.79±67.15） ng/L比（34.56±19.08） ng/L],差异有统计学意义（P＜0.01）.生存组与死亡组外周血单核细胞TLR4表达比较差异无统计学意义（P＞0.05）.给予脂多糖刺激后对照组外周血单核细胞TLR4表达较脂多糖刺激前明显升高[（50.22±19.23） MFI比（33.72±12.59） MFI],差异有统计学意义（P＜0.05）；生存组与死亡组脂多糖刺激后外周血单核细胞TLR4表达均明显降低[（4.55±2.30） MFI比（11.21±7.92） MFI、（5.46±3.44）MFI比（10.15±9.70） MFI],差异有统计学意义（P＜0.01）.生存组与死亡组细胞培养上清液TNF-α、IL-10浓度均显著低于对照组[（22.34±8.27）、（19.49±5.35） ng/L比（88.70±34.21） ng/L,（54.29±32.89）、（98.04±40.26） ng/L比（146.56±52.18） ng/L],差异有统计学意义（P＜0.01）,但死亡组IL-10浓度显著高于生存组,差异有统计学意义（P＜0.05）.结论 不同预后重症脓毒症患者,均存在内毒素耐受,在内毒素耐受情况下,单核细胞
Objective To investigate the expression of Toll-like receptor 4 （TLR4） of peripheral blood mononuclear cell （PBMC） in the different prognosis of patients with severe sepsis and its relation with endotoxin-tolerant.Methods Thirty-five patients with severe sepsis （severe sepsis group） and 15 healthy volunteers （control group）,respectively stayed in ICU 24 h and physical examination in the day measured TLR4 expression of PBMC by flow cytometry and measured the serum of tumor necrosis factor （TNF）-α and interleukin （IL）-10 by enzyme-linked immunosorbentassay.Simultaneous separation of peripheral blood of PBMC,addition of 40 μ g/ml lipopolysaccharide （LPS） cultured for 24 h,and TLR4 expression of PBMC was measured in the same manner and the culture supernatant of TNF-α and IL-10.Results Thirty-five patients with severe sepsis survivor 25 cases （survivor group） and death 10 cases （death group）,28 d death rate was 28.6% （10/35）.The TLR4 expression of PBMC in severe sepsis group was significantly lower than that in control group [（11.09 ± 8.90） MFI vs.（33.72 ± 12.59） MFI,P 〈 0.01],the serum TNF-α and IL-10 in severe sepsis group were significantly higher than those in control group [（96.66 ± 45.33） ng/L vs.（2.53 ± 1.21） ng/L,（149.79 ± 67.15） ng/L vs.（34.56 ± 19.08） ng/L,P 〈 0.01].There was no significant difference in TLR4 expression of PBMC between survivor group and death group （P 〉 0.05）.The TLR4 expression of PBMC in control group after LPS stimulation was significantly higher than that before LPS stimulation [（50.22 ± 19.23） MFI vs.（33.72 ± 12.59） MFI,P 〈 0.05],survivor group and death group after LPS stimulation were significantly lower than those before LPS stimulation [（4.55 ± 2.30） MFI vs.（11.21 ±7.92） M FI and （5.46 ± 3.44） M FI vs.（10.15 ± 9.70） MFI,P 〈 0.01].The culture supernatant of TNF-α,IL-10 in survivor group and death group were significantly lower than those in control group [（22.34
出处
《中国医师进修杂志》
2013年第12期27-30,共4页
Chinese Journal of Postgraduates of Medicine
