摘要
目的：探讨支气管肺泡灌洗（BAL）对慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）机械通气患者外周血Toll样受体4（Toll-like receptor 4,TLR4）表达水平的影响及意义.方法：选择70例COPD机械通气的患者,其中34例行常规机械通气为对照组,36例行BAL为观察组,应用荧光定量PCR测2组外周血的TLR4表达水平,同时采用ELLSA法测定血清肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-6、IL-8水平.结果：2组治疗后第1天外周血TLR4、TNF-α、IL-6和IL-8表达水平差异均无统计学意义（P＞0.05）;观察组治疗后第5天TLR4、IL-6和IL-8及治疗后第3天和第5天TNF-α均明显高于对照组（P〈0.01）.观察组在机械通气并BAL治疗后第1、3和5天TLR4、TNF-α、IL-6、IL-8表达水平差异均有统计学意义（P〈0.01）,且两两表达水平差异亦均有统计学意义（P〈0.05~P〈0.01）.对照组在机械通气治疗后第1、3和5天TLR4、TNF-α、IL-6和IL-8表达水平差异均无统计学意义（P＞0.05）.观察组中TLR4表达水平与TNF-α、IL-6、IL-8细胞因子水平均呈正相关关系（P〈0.05）.观察组在肺部感染控制窗时间、总机械通气时间、住呼吸重症监护室时间、首次撤机成功率、再上机率与同期对照组比较差异性均具有统计学意义（P〈0.05）.结论：BAL能够提高COPD机械通气患者外周血TLR4表达水平,增加脱机成功率,提示COPD治疗与机体的固有免疫相关性.
Objective： To investigate the effects of bronchoalveolar lavage on the expression of Toll-like receptor 4 （TLR4） in peripheral blood of patients with chronic obstructive pulmonary disease （COPD） and its clinical significance. Methods：Among 70 patients with mechanical ventilation of COPD, 36 cases treated with bronchoalveolar lavage and 34 cases treated with conventional mechanical ventilation were divided into the observation group and control group, respectively. The expression of TLR4 in peripheral blood were detected by Real-time PCR, and the levels of tumor necrosis factor-α （TNF-α）, interleukin （IL）-6 and IL-8 were measured using enzyme-linked immunosorbent assay in two groups. Results： The differences of TNF-α, IL-6, IL-8 and TLR4 levels in two groups on the first day after treatment with mechanical ventilation had no statistical significance（P 〉 0.05）. The levels of TLR4, IL-6 and IL- 8 in observation group on the fifth day after treatment and the level of TNF-αin observation group on the third and fifth day after treatment were significantly higher than those in control group（ P 〈 0 01 ）. The differences of TNF-cc, IL-6, IL-8 and TLR4 levels in observation group on the first, third and fifth day after treatment with mechanical ventilation combined with BAI had statistical significance（ P 〈 0. 01 ） ,the pairwise comparisons of which had statistical significance（ P 〈 0.05 to P 〈 0.01 ）. The differences of TNF- α, IL-6,IL-8 and TLR4 levels in control group on the first, third and fifth day after treatment with mechanical ventilation had no statistical significance（P 〉 0.05）. The levels of TLR4 expression and TNF-α, IL-6 and IL-8 in observation group were positive correlation（P 〈 0.05 ）. The differences of pulmonary infection control window time, total time of mechanical ventilation, ICU time, the rate of first offline and online again in two groups had statistical significance（P 〈 0.05）. Conclusions ：The bronchoalveolar lavage can rais
出处
《蚌埠医学院学报》
CAS
2013年第12期1597-1600,共4页
Journal of Bengbu Medical College
