中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
19期
8577-8583
,共7页
林闽加%李红强%程婷婷%许淑敏%张斗霞%白建文
林閩加%李紅彊%程婷婷%許淑敏%張鬥霞%白建文
림민가%리홍강%정정정%허숙민%장두하%백건문
肺炎%Toll样受体2%Toll样受体4%髓样分化因子88%扶正利肺汤
肺炎%Toll樣受體2%Toll樣受體4%髓樣分化因子88%扶正利肺湯
폐염%Toll양수체2%Toll양수체4%수양분화인자88%부정리폐탕
Pneumonia%Toll-Like Receptor 2%Toll-Like Receptor 4%Myeloid differentiation factor 88%FuZhengLiFei decoction
目的：观察扶正利肺汤对老年社区获得性肺炎患者外周血中性粒细胞Toll样受体（TLRs）2、4，髓样分化因子88（MyD88）mRNA 表达及对细胞因子的调节作用和临床疗效。方法以老年肺炎患者（中西医结合治疗组A，n＝38，抗生素治疗组B，n＝32）和对照者C组（n＝25）作为研究对象。分离外周血中性粒细胞，提取中性粒细胞mRNA，实时定量-PCR检测各组TLR2，TLR4及MyD88 mRNA表达；采用ELISA检测外周血上清肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）浓度并观察临床表现。结果对照组外周血中性粒细胞有基础的TLR2、TLR4和MyD88 mRNA表达和外周血TNF-α、IL-6产生，分别是0.812±0.227，0.021±0.017，0.948±0.082和（9.520±3.009）pg/ml，（28.820±8.172）pg/ml；而老年肺炎（A组、B组）患者以上指标均显著升高，A组分别是1.096±0.181，0.039±0.023，1.031±0.088和（25.810±6.737）pg/ml，（65.660±21.296）pg/ml；B组分别是1.061±0.226，0.037±0.022，1.029±0.072和（26.160±7.349）pg/ml，（65.960±19.586）pg/ml，较对照组比较差异有统计学意义（P＜0.05）。两组治疗后均使TLR2、TLR4和Myd88 mRNA相对表达量下降，虽然无统计学差异，但A组治疗后TLR2 mRNA和TLR4 mRNA降低趋势更明显，P均＜0.10；两组（A组、B组）治疗后TNF-α和IL-6浓度均显著下降， TNF-α分别为（15.050±3.925）pg/ml，（16.250±3.320）pg/ml，IL-6分别为（39.900±1.634）pg/ml，（40.610±1.836）pg/ml，治疗前后比较差异有统计学意义，分别为t＝4.254、3.816、3.734、4.007，P＝0.002、0.004、0.005、0.003；治疗后两组比较差异无统计学意义（P＝0.470，P＝0.372）；但A组发热持续时间显著缩短，差异有统计学意义（t＝5.018，P＝0.001）；肺部炎症吸收更明显，差异有统计学意义（χ2＝4.119， P＝0.042）；同时抗生素治疗时间亦缩短，差异亦有统计学意义（t＝3.003，P＝0.008）。结论中性粒细胞TLR2、TLR4-MyD88信号传导通路在老年社区获得性肺炎发生发展中起一定作用。虽然扶正利肺汤单独治疗尚不能影响患者中性粒细胞TLR2、TLR4-Myd88 mRNA的表达及细胞因子的释放，但在改善症状、肺部炎症吸收及减少抗生素使用均有益处，提示合理有效抗生素治疗协同扶正利肺汤治疗可能是老年人肺炎治疗新的启示。
目的：觀察扶正利肺湯對老年社區穫得性肺炎患者外週血中性粒細胞Toll樣受體（TLRs）2、4，髓樣分化因子88（MyD88）mRNA 錶達及對細胞因子的調節作用和臨床療效。方法以老年肺炎患者（中西醫結閤治療組A，n＝38，抗生素治療組B，n＝32）和對照者C組（n＝25）作為研究對象。分離外週血中性粒細胞，提取中性粒細胞mRNA，實時定量-PCR檢測各組TLR2，TLR4及MyD88 mRNA錶達；採用ELISA檢測外週血上清腫瘤壞死因子-α（TNF-α）、白細胞介素-6（IL-6）濃度併觀察臨床錶現。結果對照組外週血中性粒細胞有基礎的TLR2、TLR4和MyD88 mRNA錶達和外週血TNF-α、IL-6產生，分彆是0.812±0.227，0.021±0.017，0.948±0.082和（9.520±3.009）pg/ml，（28.820±8.172）pg/ml；而老年肺炎（A組、B組）患者以上指標均顯著升高，A組分彆是1.096±0.181，0.039±0.023，1.031±0.088和（25.810±6.737）pg/ml，（65.660±21.296）pg/ml；B組分彆是1.061±0.226，0.037±0.022，1.029±0.072和（26.160±7.349）pg/ml，（65.960±19.586）pg/ml，較對照組比較差異有統計學意義（P＜0.05）。兩組治療後均使TLR2、TLR4和Myd88 mRNA相對錶達量下降，雖然無統計學差異，但A組治療後TLR2 mRNA和TLR4 mRNA降低趨勢更明顯，P均＜0.10；兩組（A組、B組）治療後TNF-α和IL-6濃度均顯著下降， TNF-α分彆為（15.050±3.925）pg/ml，（16.250±3.320）pg/ml，IL-6分彆為（39.900±1.634）pg/ml，（40.610±1.836）pg/ml，治療前後比較差異有統計學意義，分彆為t＝4.254、3.816、3.734、4.007，P＝0.002、0.004、0.005、0.003；治療後兩組比較差異無統計學意義（P＝0.470，P＝0.372）；但A組髮熱持續時間顯著縮短，差異有統計學意義（t＝5.018，P＝0.001）；肺部炎癥吸收更明顯，差異有統計學意義（χ2＝4.119， P＝0.042）；同時抗生素治療時間亦縮短，差異亦有統計學意義（t＝3.003，P＝0.008）。結論中性粒細胞TLR2、TLR4-MyD88信號傳導通路在老年社區穫得性肺炎髮生髮展中起一定作用。雖然扶正利肺湯單獨治療尚不能影響患者中性粒細胞TLR2、TLR4-Myd88 mRNA的錶達及細胞因子的釋放，但在改善癥狀、肺部炎癥吸收及減少抗生素使用均有益處，提示閤理有效抗生素治療協同扶正利肺湯治療可能是老年人肺炎治療新的啟示。
목적：관찰부정리폐탕대노년사구획득성폐염환자외주혈중성립세포Toll양수체（TLRs）2、4，수양분화인자88（MyD88）mRNA 표체급대세포인자적조절작용화림상료효。방법이노년폐염환자（중서의결합치료조A，n＝38，항생소치료조B，n＝32）화대조자C조（n＝25）작위연구대상。분리외주혈중성립세포，제취중성립세포mRNA，실시정량-PCR검측각조TLR2，TLR4급MyD88 mRNA표체；채용ELISA검측외주혈상청종류배사인자-α（TNF-α）、백세포개소-6（IL-6）농도병관찰림상표현。결과대조조외주혈중성립세포유기출적TLR2、TLR4화MyD88 mRNA표체화외주혈TNF-α、IL-6산생，분별시0.812±0.227，0.021±0.017，0.948±0.082화（9.520±3.009）pg/ml，（28.820±8.172）pg/ml；이노년폐염（A조、B조）환자이상지표균현저승고，A조분별시1.096±0.181，0.039±0.023，1.031±0.088화（25.810±6.737）pg/ml，（65.660±21.296）pg/ml；B조분별시1.061±0.226，0.037±0.022，1.029±0.072화（26.160±7.349）pg/ml，（65.960±19.586）pg/ml，교대조조비교차이유통계학의의（P＜0.05）。량조치료후균사TLR2、TLR4화Myd88 mRNA상대표체량하강，수연무통계학차이，단A조치료후TLR2 mRNA화TLR4 mRNA강저추세경명현，P균＜0.10；량조（A조、B조）치료후TNF-α화IL-6농도균현저하강， TNF-α분별위（15.050±3.925）pg/ml，（16.250±3.320）pg/ml，IL-6분별위（39.900±1.634）pg/ml，（40.610±1.836）pg/ml，치료전후비교차이유통계학의의，분별위t＝4.254、3.816、3.734、4.007，P＝0.002、0.004、0.005、0.003；치료후량조비교차이무통계학의의（P＝0.470，P＝0.372）；단A조발열지속시간현저축단，차이유통계학의의（t＝5.018，P＝0.001）；폐부염증흡수경명현，차이유통계학의의（χ2＝4.119， P＝0.042）；동시항생소치료시간역축단，차이역유통계학의의（t＝3.003，P＝0.008）。결론중성립세포TLR2、TLR4-MyD88신호전도통로재노년사구획득성폐염발생발전중기일정작용。수연부정리폐탕단독치료상불능영향환자중성립세포TLR2、TLR4-Myd88 mRNA적표체급세포인자적석방，단재개선증상、폐부염증흡수급감소항생소사용균유익처，제시합리유효항생소치료협동부정리폐탕치료가능시노년인폐염치료신적계시。
Objective To investigate whether FuZhengLiFei decoction could have a role in regulating expression of Toll like receptors (TLRs) 2, 4 and myeloid differentiation factor 88 (MyD88) mRNA of peripheral neutrophils and cytokones and clinical effect in olderly patients from pneumonia. Methods Elderly patients with pneumonia (treatment group A of combination of Chinese and Western medicine, n=38; treatment group B of antibiotics, n=32) and control group C (n=25) were selected as research subjects. Neutrophils isolated from patients and controls and neutrophils mRNA extracted. Expression of TLR2, TLR4 and MyD88 mRNA were measured by Real-time PCR. Cytokines (TNF-α and IL-6) in serum were also tested by ELISA and clinical manifestations were observed. Results Peripheral neutrophils of control group have a foundation of TLR2, TLR4 and MyD88 mRNA expression and production of TNF-α, IL-6, the results were 0.812±0.227, 0.021±0.017, 0.948±0.082 and (9.520±3.009) pg/ml, (28.820±8.172) pg/ml respectively and elderly patients with pneumonia were significantly elevated above indicators, group A were 1.096±0.181, 0.039±0.023, 1.031±0.088 and (25.810±6.737) pg/ml, (65.660±21.296) pg/ml respectively and group B were 1.061±0.226, 0.037±0.022, 1.029±0.072 and (26.160±7.349)pg/ml, (65.960±19.586) pg/ml. Compared with control group, difference was statistically significant (P values were less than 0.05). After treatment, TLR2, TLR4 and MyD88 mRNA relative expression were declined in both of treatment group, but no statistically significant difference and a decreasing trends was more obvious in group A (P values were less than 0.1). TNF-α and IL-6 levels were significantly decreased after both treatment(A, B), they were (15.050±3.925), (16.250±3.320)pg/ml and (39.900±1.634) pg/ml, (40.610±1.836) pg/ml respectively (t=4.254, 3.816, 3.734, 4.007, P=0.002, 0.004, 0.005, 0.003), but compared with no significant difference after both treatment in the concentration of reducing (P=0.47, P=0.727). Group A of duration of fever and antibiotic usage time were more shorter than group B (t=5.018, P=0.001;t=3.003, P=0.008) and the inflammation in the lung was also significantly improved (χ2=4.119, P=0.042). Conclusion These data suggest that neutrophil TLR2, TLR4 and MyD88 signaling contribute to the development of community acquired pneumonia in the elderly. There are no significant effect of FuZhengLiFei decoction on the expression of Toll like receptors(TLRs) 2, 4 and myeloid differentiation factor 88(MyD88) mRNA of peripheral neutrophils and cytokones from pneumonia in the olderly, but it is beneficial to improving clinical manifestation and absorption of inflammation of lung and reducing use of antibiotics. Suggesting that collaboration with antibiotic and FuZhengLiFei decoction may be a new arousing for treatment of pneumonia in the olderly.
