摘要
目的分析Toll样受体(TLRs)/核因子κB(NF-κB)信号通路及T淋巴细胞与重症肺炎患者预后的关系。方法本研究为病例对照研究。采用非随机抽样的方法选取2019年1月至2022年5月合肥市第二人民医院收治的90例重症肺炎患者。根据入院28 d存活与否分为存活组(67例)与死亡组(23例)。比较2组患者入院24 h内外周血单个核细胞TLR4蛋白、NF-κB蛋白、磷酸化κB抑制蛋白(p-IκB)表达情况及炎症因子[白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)]水平,并分析2组患者入院24 h内T淋巴细胞亚群CD3^(+)、CD4^(+)、CD8+表达情况。绘制受试者工作特性(ROC)曲线评价TLRs/NF-κB信号通路相关蛋白及炎症因子、T淋巴细胞对重症肺炎患者28 d死亡风险的预测效能。结果存活组外周血单个核细胞TLR4蛋白、NF-κB蛋白、p-IκB蛋白表达及IL-6、TNF-α、CRP水平均低于死亡组,分别为TLR4蛋白(0.59±0.16)比(0.67±0.15)、NF-κB蛋白(0.57±0.15)比(0.65±0.13)、p-IκB蛋白(0.55±0.12)比(0.62±0.13)、IL-6(34.60±8.20)比(40.19±8.54)、TNF-α(32.62±8.19)比(37.10±8.57)、CRP(13.24±4.21)比(18.58±5.46),差异均有统计学意义(t值分别为2.10、2.28、2.36、2.79、2.24、4.85,均P<0.05)。存活组T淋巴细胞亚群CD3^(+)、CD4^(+)表达均高于死亡组[(61.78±5.69)%比(57.12±5.19)%、(31.58±4.47)%比(27.76±4.23)%,t值分别为3.46、3.58,均P<0.05];2组T淋巴细胞亚群CD8+表达差异无统计学意义[(29.01±3.63)%比(30.69±3.50)%,t=1.93,P=0.057)。ROC曲线结果显示,外周血单个核细胞TLR4蛋白、NF-κB蛋白、p-IκB蛋白及IL-6、TNF-α、CRP和T淋巴细胞亚群CD3^(+)、CD4^(+)对重症肺炎患者28 d死亡风险均有一定预测效能,曲线下面积分别为0.825、0.815、0.811、0.712、0.776、0.728、0.732和0.713。结论重症肺炎患者存在TLRs/NF-κB信号通路异常激活、炎性反应强烈和免疫功能紊乱情况。外周血单个核细胞TLR4蛋白、NF-κB蛋白、p-IκB
Objective To analyze the relationship between toll like receptors(TLRs)/nuclear factor-κB(NF-κB)signaling pathway and T lymphocytes and the prognosis of patients with severe pneumonia.Methods This was a case control study.Non-random sampling method was used to select 90 patients with severe pneumonia admitted to our hospital from January 2019 to May 2022.According to whether they survived 28 days after admission,they were divided into survival group(67 cases)and death group(23 cases).The expressions of toll-like receptor 4(TLR4)protein,NF-κB protein,phosphorylated inhibitor of kappa B(p-IκB),and inflammatory factors(interleukin-6[IL-6],tumor necrosis factor-α[TNF-α],C-reactive protein[CRP])in peripheral blood mononuclear cells within 24 hours after admission were compared between the two groups.The expressions of T lymphocyte subsets CD3^(+),CD4^(+),and CD8+within 24 hours after admission were analyzed in the two groups.Receiver operating characteristic(ROC)curve was drawn to evaluate the predictive efficacy of TLRs/NF-κB signaling pathway related proteins,inflammatory factors,and T lymphocytes on 28-day mortality risk of patients with severe pneumonia.Results The expressions of TLR4 protein,NF-κB protein,p-IκB protein,IL-6,TNF-α,and CRP in peripheral blood mononuclear cells of survival group and of death group were(0.59±0.16)versus(0.67±0.15),(0.57±0.15)versus(0.65±0.13),(0.55±0.12)versus(0.62±0.13),(34.60±8.20)versus(40.19±8.54),(32.62±8.19)versus(37.10±8.57),and(13.24±4.21)versus(18.58±5.46),respectively,with all the former lower than the latter(t=2.10,2.28,2.36,2.79,2.24,and 4.85,all P<0.05).The expressions of T lymphocyte subsets CD3^(+)and CD4^(+)in survival group and in death group were(61.78±5.69)%versus(57.12±5.19)%and(31.58±4.47)%versus(27.76±4.23)%,respectively,with the former higher than the latter(t=3.46 and 3.58,both P<0.05).There was no significant difference in T lymphocyte subset CD8+expression between the two groups,with(29.01±3.63)%versus(30.69±3.50)%,(t=1.93,P=0.057
作者
张雅迪
杜方兵
唐思慧
杨万春
Zhang Yadi;Du Fangbing;Tang Sihui;Yang Wanchun(Department of Respiratory and Critical Care Medicine,the Second People′s Hospital of Hefei,Hefei Hospital Affiliated to Auhui Medical University,Hefei 230001,China)
出处
《国际呼吸杂志》
2023年第1期75-80,共6页
International Journal of Respiration
基金
安徽医科大学基础与临床合作研究提升计划(2021xkjT040)。
