CAJ | 학술논문

　　目的通过观察阻塞性黄疸患者肝损伤程度与TLR4的相关性，探讨TLR4信号通路在阻塞性黄疸患者肝损伤中的作用。方法择期手术患者40例，梗黄组（Ⅰ组）20例，胆囊及胆管结石，有明显梗阻性黄疸及肝功能障碍，拟行胆囊切除胆总管探查手术的患者，ASAⅢ级；对照组（Ⅱ组） ASAⅠ～Ⅱ级20例肝功能正常，有胆囊及胆管结石但无梗阻性黄疸的患者，拟行胆总管探查术。两组患者均于术前1d早晨重新抽取静脉血用全自动生化分析仪测定血清谷丙转氨酶（ALT）、总胆红素（TBI）等肝功能指标。术中取约3～5g肝组织保存于-20°冰箱，酶联免疫吸附法检测肝脏组织TLR4浓度。结果①两组病例一般情况比较：两组之间年龄、性别、体质量、病程方面差异无统计学意义。②Ⅰ组血清谷丙转氨酶（ALT）、总胆红素（TBI）明显高于Ⅱ组（P＜0.01）；而血浆白蛋白，白蛋白/球蛋白（A/G）明显低于Ⅱ组（P＜0.05）。③ALT与肝组织TLR4的变化呈正相关（R=0.992，P＜0.01）。结论梗阻性黄疸患者均存在较严重的肝功能损害，其发生机制可能与肝组织中TLR4表达增高有关。
　　목적통과관찰조새성황달환자간손상정도여TLR4적상관성，탐토TLR4신호통로재조새성황달환자간손상중적작용。방법택기수술환자40례，경황조（Ⅰ조）20례，담낭급담관결석，유명현경조성황달급간공능장애，의행담낭절제담총관탐사수술적환자，ASAⅢ급；대조조（Ⅱ조） ASAⅠ～Ⅱ급20례간공능정상，유담낭급담관결석단무경조성황달적환자，의행담총관탐사술。량조환자균우술전1d조신중신추취정맥혈용전자동생화분석의측정혈청곡병전안매（ALT）、총담홍소（TBI）등간공능지표。술중취약3～5g간조직보존우-20°빙상，매련면역흡부법검측간장조직TLR4농도。결과①량조병례일반정황비교：량조지간년령、성별、체질량、병정방면차이무통계학의의。②Ⅰ조혈청곡병전안매（ALT）、총담홍소（TBI）명현고우Ⅱ조（P＜0.01）；이혈장백단백，백단백/구단백（A/G）명현저우Ⅱ조（P＜0.05）。③ALT여간조직TLR4적변화정정상관（R=0.992，P＜0.01）。결론경조성황달환자균존재교엄중적간공능손해，기발생궤제가능여간조직중TLR4표체증고유관。
Objective To study the roles of TLR4 in obstructive jaundice liver injury. Methods Forty patients undergoing elective surgery under general anesthesia were randomly divided into two groups:(Ⅰ)heptoses group included 20 ASA III patients with obstructive jaundice and (II) control group included 20 ASA I~II patients with normal liver function. All patients received a combined anesthesia with propofol, remifentanyl and cisatracurium . alanine aminotransferase(ALT)and total bilirubin(TBI)were measured. Expression of TLR4 proteins in liver tissues were measured with ELISA. Results The demographic data including sex, age and weight were comparable between two groups. ALT,TBI and TLR4 in I group increased significantly compared with those in II group(P<0.01). Meanwhile,TLR4 was significantly positively correlated with ALT(r=0.992,P<0.01). Conclusion Obstructive jaundice induced severe liver injury in patients. Expression of TLR4 aggravates obstructive jaundice liver injury throμgh LPS-TLR4-NF-κB pathway.