CAJ | 학술논문

目的研究老年重症肺炎（severe pneumonia，SP）患者外周血单核细胞Toll样受体2/4（Toll-like receptor 2/4） mRNA和蛋白表达变化规律及其与临床预后的关系。方法选取2010年1月至2011年9月入住我科的老年重症肺炎患者40例，选择20例健康老年体检者作为对照组。 RT-PCR及流式细胞术分别检测试验组入组当时、3 d及7 d和对照组外周血单核细胞TLR2/4表达，ELISA法检测患者组TNF-α、IL-1和IL-6水平，并进行APACHEⅡ和CURB-65评分，常规检测CRP和PCT。所有患者随访28 d，根据预后分为存活组和死亡组。结果试验组各时间点外周血单核细胞TLR2/4 mRNA和蛋白水平均明显高于健康对照组（P均＜0.05）。与确诊时（T1）相比，试验组第3天（T2）和第7天（T3）TLR2/4 mRNA及蛋白表达均下调（P＜0.05）。所有患者随访28 d，死亡率30％，存活组APACHEⅡ评分、CURB-65评分和PCT水平明显低于死亡组（ P＜0.05或P＜0.01），存活组各时间点外周血单核细胞TLR2/4蛋白表达均明显高于死亡组（ P＜0.05）。老年重症肺炎患者外周血单核细胞TLR2及TLR4表达强度与血清IL-1、IL-6浓度成正相关（ r＝0.3985和0.4073，P均＜0.01）。结论老年重症肺炎患者外周血单核细胞TLR2/4表达水平高于健康对照组，而且TLR2/4的表达下调与死亡结局相关。
목적연구노년중증폐염（severe pneumonia，SP）환자외주혈단핵세포Toll양수체2/4（Toll-like receptor 2/4） mRNA화단백표체변화규률급기여림상예후적관계。방법선취2010년1월지2011년9월입주아과적노년중증폐염환자40례，선택20례건강노년체검자작위대조조。 RT-PCR급류식세포술분별검측시험조입조당시、3 d급7 d화대조조외주혈단핵세포TLR2/4표체，ELISA법검측환자조TNF-α、IL-1화IL-6수평，병진행APACHEⅡ화CURB-65평분，상규검측CRP화PCT。소유환자수방28 d，근거예후분위존활조화사망조。결과시험조각시간점외주혈단핵세포TLR2/4 mRNA화단백수평균명현고우건강대조조（P균＜0.05）。여학진시（T1）상비，시험조제3천（T2）화제7천（T3）TLR2/4 mRNA급단백표체균하조（P＜0.05）。소유환자수방28 d，사망솔30％，존활조APACHEⅡ평분、CURB-65평분화PCT수평명현저우사망조（ P＜0.05혹P＜0.01），존활조각시간점외주혈단핵세포TLR2/4단백표체균명현고우사망조（ P＜0.05）。노년중증폐염환자외주혈단핵세포TLR2급TLR4표체강도여혈청IL-1、IL-6농도성정상관（ r＝0.3985화0.4073，P균＜0.01）。결론노년중증폐염환자외주혈단핵세포TLR2/4표체수평고우건강대조조，이차TLR2/4적표체하조여사망결국상관。
Objective To observe the relationship between Toll-like receptor 2, 4 ( TLR2/4 ) and the pathophysiological effects and prognosis of elderly patients with severe pneumonia .Methods Forty elderly patients with severe pneumonia in the ICU were included and followed up for 28 days and then assigned to survival group and non-survival group respectively .Twenty healthy people were enrolled in the control group .The concentration of TLR 2/4 mRNA and TLR2/4 protein in the monocytes of peripheral blood of the study group were measured by real -time PCR and flow cytometry in the diagnosed(T1)and the 3rd(T2)and 7th(T3)day.The concentration of TNF-α,IL-1 and IL-6 in the serum were measured by ELISA .APACHEII and CURB-65 were calculated .C-reaction protein and procalcitonin were routinely measured .Results An increased expression of TLR2/4 mRNA and TLR2/4 protein were found in study group at all time points compared to healthy adults (P<0.05).The expression of TLR2/4 mRNA and protein of the study group at T 2 and T3 were down-regulated compared to that of T 1 ( P<0.05 ) .All patients were followed 28 days and the mortality rate was 30%.APACHE II score and CURB-65 were lower in survivors than non-survivors(P<0.05 or P<0.01).The expression of TLR42/mRNA and protein in the survival group were higher than those in non-survival group ( P<0.05 ) .There was positive correlation between the expression of TLR 2/4 and the concentration of both IL-1 and IL-6 in the serum ( r =0.3985 and 0.4073 respectively, P <0.05 ). Conclusions The dynamic expression of Toll-like receptor 2 and 4 on blood monocytes in the elderly patients with severe pneumonia are higher than healthy controls .There is a tendency that severe pneumonia mortality in elderly patients is associated with down-regulation expression of Toll-like receptors 2 and 4 on blood monocytes .