中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2011年
8期
475-477
,共3页
陈德晖%黎毅敏%蓝淑玲%潘小安%周蕾%粱铭%卢慧敏%陈福雄
陳德暉%黎毅敏%藍淑玲%潘小安%週蕾%粱銘%盧慧敏%陳福雄
진덕휘%려의민%람숙령%반소안%주뢰%량명%로혜민%진복웅
Toll样受体4%细胞因子%脓毒症%儿童
Toll樣受體4%細胞因子%膿毒癥%兒童
Toll양수체4%세포인자%농독증%인동
Toll-like receptor 4%Cytokine%Sepsis%Children
目的 探讨Toll样受体4(TLR4)水平在严重脓毒症患儿中的临床意义.方法 采用前瞻性病例对照研究方法,选择儿科重症监护病房(ICU)住院且诊断符合严重脓毒症、脓毒性休克患儿14例(严重脓毒症组),以同期住院的支气管肺炎患儿(肺炎组)及健康体检儿童(健康对照组)各10例作为对照.取患儿入院时静脉血2 ml,用流式细胞仪检测TLR4水平,用酶联免疫吸附法(ELISA)测定血清白细胞介察(IL-6、IL-10)、肿瘤坏死因子-α(TNF-α)含量.结果 严重脓毒症组TLR4[(71.56±15.32)%]、IL-6[(1.98±1.55)ng/L]、IL-10[(88.20±61.23)ng/L]、TNF-α[(104.08±85.36)ng/L]水平均显著高于肺炎组[分别为(50.07±26.36)%、(0.93±0.16)ng/L、(41.42±7.02)ng/L、(48.96±6.40)ng/L]与健康对照组[分别为(39.43±17.43)%、(0.94±0.43)ng/L、(43.73±22.68)ng/L、(49.94±18.47)ng/L],差异均有统计学意义(均P＜0.05);而肺炎组与健康对照组间比较差异均无统计学意义(均P＞0.05).结论 TLR4是脓毒症发生与发展的启动点,其水平与促炎因子IL-6、TNF-α及抗炎因子IL-10水平一致;若将TLR4的变化与部分炎症介质水平相互结合,可作为脓毒症患儿早期诊断和病情严重程度的预测指标.
目的 探討Toll樣受體4(TLR4)水平在嚴重膿毒癥患兒中的臨床意義.方法 採用前瞻性病例對照研究方法,選擇兒科重癥鑑護病房(ICU)住院且診斷符閤嚴重膿毒癥、膿毒性休剋患兒14例(嚴重膿毒癥組),以同期住院的支氣管肺炎患兒(肺炎組)及健康體檢兒童(健康對照組)各10例作為對照.取患兒入院時靜脈血2 ml,用流式細胞儀檢測TLR4水平,用酶聯免疫吸附法(ELISA)測定血清白細胞介察(IL-6、IL-10)、腫瘤壞死因子-α(TNF-α)含量.結果 嚴重膿毒癥組TLR4[(71.56±15.32)%]、IL-6[(1.98±1.55)ng/L]、IL-10[(88.20±61.23)ng/L]、TNF-α[(104.08±85.36)ng/L]水平均顯著高于肺炎組[分彆為(50.07±26.36)%、(0.93±0.16)ng/L、(41.42±7.02)ng/L、(48.96±6.40)ng/L]與健康對照組[分彆為(39.43±17.43)%、(0.94±0.43)ng/L、(43.73±22.68)ng/L、(49.94±18.47)ng/L],差異均有統計學意義(均P＜0.05);而肺炎組與健康對照組間比較差異均無統計學意義(均P＞0.05).結論 TLR4是膿毒癥髮生與髮展的啟動點,其水平與促炎因子IL-6、TNF-α及抗炎因子IL-10水平一緻;若將TLR4的變化與部分炎癥介質水平相互結閤,可作為膿毒癥患兒早期診斷和病情嚴重程度的預測指標.
목적 탐토Toll양수체4(TLR4)수평재엄중농독증환인중적림상의의.방법 채용전첨성병례대조연구방법,선택인과중증감호병방(ICU)주원차진단부합엄중농독증、농독성휴극환인14례(엄중농독증조),이동기주원적지기관폐염환인(폐염조)급건강체검인동(건강대조조)각10례작위대조.취환인입원시정맥혈2 ml,용류식세포의검측TLR4수평,용매련면역흡부법(ELISA)측정혈청백세포개찰(IL-6、IL-10)、종류배사인자-α(TNF-α)함량.결과 엄중농독증조TLR4[(71.56±15.32)%]、IL-6[(1.98±1.55)ng/L]、IL-10[(88.20±61.23)ng/L]、TNF-α[(104.08±85.36)ng/L]수평균현저고우폐염조[분별위(50.07±26.36)%、(0.93±0.16)ng/L、(41.42±7.02)ng/L、(48.96±6.40)ng/L]여건강대조조[분별위(39.43±17.43)%、(0.94±0.43)ng/L、(43.73±22.68)ng/L、(49.94±18.47)ng/L],차이균유통계학의의(균P＜0.05);이폐염조여건강대조조간비교차이균무통계학의의(균P＞0.05).결론 TLR4시농독증발생여발전적계동점,기수평여촉염인자IL-6、TNF-α급항염인자IL-10수평일치;약장TLR4적변화여부분염증개질수평상호결합,가작위농독증환인조기진단화병정엄중정도적예측지표.
Objective To study the clinical significance of Toll-like receptor 4 (TLR4) in children with severe sepsis. Methods A prospective control study was performed. All cases were enrolled from pediatric department of the First Affiliated Hospital of Guangzhou Medical College, and they were divided into severe sepsis group (14 patients) who were diagnosed to have severe sepsis or septic shock in intensive care unit (ICU), pneumonia group (10 cases) with diagnosis of bronchial pneumonia, and healthy control group (10 healthy children). Venous blood samples of 2 ml were collected at admission, the level of TLR4 was detected by flow cytometry . At the same time, the changes in serum interleukin (IL-6, IL-10 ) and tumor necrosis factor-α (TNF-α) levels were determined by enzyme linked immunoadsorbent assay (ELISA).Results In severe sepsis group, the contents of TLR4[(71. 56±15.32)%], IL-6[(1. 98±1.55) ng/L],IL-10[(88. 20±61.23) ng/L]and TNF-α[(104. 08±85.36) ng/L]were significantly higher than those in pneumonia group[(50. 07 ± 26.36) %, (0. 93 ± 0. 16) ng/L, (41.42 ± 7.02) ng/L, (48. 96 ± 6. 40) ng/L]and healthy control group[(39. 43± 17.43)%, (0. 94± 0. 43) ng/L, (43.73 ± 22.68) ng/L, (49. 94±18. 47) ng/L, all P＜0. 05). But there was no significant difference in the contents of TLR4, IL-6, IL-10 and TNF-α between pneumonia group and healthy control group (all P＞0. 05). Conclusion This study suggests that TLR4 might be critically involved in the development of sepsis, and changes in TLR4 expression are parallel with levels of proinflammatory cytokines, including IL-6, TNF-α, and IL-10. The combination of TLR4 and proinflammatory cytokines would serve as the predictive parameters in early diagnosis and severity evaluation of sepsis in children.
