CAJ | 학술논문

目的探讨外周血有核细胞Toll受体-4(toll like recepter-4,TLR-4)mRNA在急性脑血管病(acute cerebrovascular disease,ACVD)引发伞身炎症反应综合征(systemic infammatory response syndrome,SIRS)及多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)发病过程中的表达规律以及与病情变化的相关性.方法 153例急性脑血管病患者来自2005年10月争2006年3月吉林大学第一、二、四医院神经内科及ICU住院患者,于发病3 d内入院,经过头部CT或MRI榆查确诊.采用前瞻性研究方法,分为单纯ACVD组60例,ACVD引发SIRS组45例,ACVD引发MODS组48例,诊断标准:均符合中国第四届腑血管学术会议各类脑血管病的诊断标准.排除标准:(1)发病前两周内有过感染或炎症性疾病病史;(2)部分心脏疾患,包括急性心肌炎、急性冠状血管疾病(如急性心肌梗死、心绞痛等)及心脏瓣膜病等;(3)近期使用过激素;(4)恶性肿瘤、自身免疫系统疾病、肝脏、肾脏、血液疾病等.采用逆转录酶聚合酶链反应测定急性脑血管病患者外周血有核细胞TIB-4 mRNA表达.两组间比较采用t检验,多组间比较采用单凶素方筹分析,多组间两两比较采用q检验.结果患者发病第3日TLR-4 mRNA表达明显升高;对于TLR-4 mRNA的表达,ACVD引发SIRS组与单纯ACVD组相比(P＜0.01),ACVD引发MODS组与ACVD引发SIRS绀相比较(P＜0.01),而且其表达升高的程度随着病情的加重而呈升高趋势;MODS积分越高,TLR-4 mRNA的表达也越高,且 P＜0.01;ACVD引发MODS患者中,死亡组与存活组相比较,死亡绀的血清TLR-4 mRNA的表达明显高于存活组(P＜0.01).结论 ACVD这一外源性非感染疾病可以引发SIRS和MODS的机制可能与机体过度免疫应答有关.
목적 탐토외주혈유핵세포Toll수체-4(toll like recepter-4,TLR-4)mRNA재급성뇌혈관병(acute cerebrovascular disease,ACVD)인발산신염증반응종합정(systemic infammatory response syndrome,SIRS)급다기관공능장애종합정(multiple organ dysfunction syndrome,MODS)발병과정중적표체규률이급여병정변화적상관성.방법 153례급성뇌혈관병환자래자2005년10월쟁2006년3월길림대학제일、이、사의원신경내과급ICU주원환자,우발병3 d내입원,경과두부CT혹MRI유사학진.채용전첨성연구방법,분위단순ACVD조60례,ACVD인발SIRS조45례,ACVD인발MODS조48례,진단표준:균부합중국제사계부혈관학술회의각류뇌혈관병적진단표준.배제표준:(1)발병전량주내유과감염혹염증성질병병사;(2)부분심장질환,포괄급성심기염、급성관상혈관질병(여급성심기경사、심교통등)급심장판막병등;(3)근기사용과격소;(4)악성종류、자신면역계통질병、간장、신장、혈액질병등.채용역전록매취합매련반응측정급성뇌혈관병환자외주혈유핵세포TIB-4 mRNA표체.량조간비교채용t검험,다조간비교채용단흉소방주분석,다조간량량비교채용q검험.결과 환자발병제3일TLR-4 mRNA표체명현승고;대우TLR-4 mRNA적표체,ACVD인발SIRS조여단순ACVD조상비(P＜0.01),ACVD인발MODS조여ACVD인발SIRS감상비교(P＜0.01),이차기표체승고적정도수착병정적가중이정승고추세;MODS적분월고,TLR-4 mRNA적표체야월고,차 P＜0.01;ACVD인발MODS환자중,사망조여존활조상비교,사망감적혈청TLR-4 mRNA적표체명현고우존활조(P＜0.01).결론 ACVD저일외원성비감염질병가이인발SIRS화MODS적궤제가능여궤체과도면역응답유관.
Objective To study the expression of toll rexeptor-4 in patients with systemic infanunatory response syndrome(SIRS)and multiple organ dysfunction syndrome (MODS) induced by acute cerebral vascular disease(ACVD).Method Totally 153 ACVD patients,admitted to Departments of Neurology Medicine and ICU of the First,the Second and the Forth Hospitals of Jilin University from October 2005 to March 2006,were enrolled in this study.The patients were admitted to the hospitals within 3 days after onset,and were confirmed by CT or MRI.The 153 patients in the prospective study was divided into three groupa:ACVD group(n=60).SIRS group induced by ACVD(n=45),MODS group induced by ACVD(n=48).The diagnosis criteria accorded with the criterion set by the Forth Conference of Cerebrovuscular Disease in China.The exclusion criterion inchided:①patients with infeetion or inflammatory disease two weeks before the onset of AVCD;②patients with cardiac disease,including acute myocarditis,acute myocardial infarction,angina episodes,degenerative calcific valvular disease,and so on;③patients with use of hormone recently;④malignant tumor,autoimmunity system disease,liver disease,kidney disease and hematologic disease.The expression of TLR-4 mRNA gene of the nucleated cell in the peripheral blood in the ACVD patient was measured by using RT-PCR.Statistics methods of t test,q test and simplex factor analysis of variance have been used Statistical analysis was carried out by using T-test,one-way analysis of variances,and q-test.Results The expression of TLR-4mRNA obviously increased on the third day after onset of AVCD.Compared with ACVD group,the expression of TLR-4mRNA in SIRS group was significantly higher (0.61±0.13 vs.0.98±0.15,P＜0.01).Compared with SIRS group,the expression of TLR-4mRNA in MODS group was significantly higher(0.98±0.15 vs.1.32±0.38,P＜0.01).The expression of TLR-4mRNA had a increasing tendency with the severity of AVCD.The expression of TLR-4mRNA was higher in patients with higher MODS score(P＜0.01).In the MODS group,the expression of TLR-4 mRNA was higher in the fatal patients than that in the survivors(1.56±0.16 vs.1.32±0.26,P＜0.01).Conclusions The mechanism of ACVD.which causes SIRS and MODS,may be associated with excessive immunologic respun of the organism.