中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2013年
12期
27-30
,共4页
郭皓%要跟东%栾玉杰%张山%张天敏
郭皓%要跟東%欒玉傑%張山%張天敏
곽호%요근동%란옥걸%장산%장천민
Toll样受体4%脓毒症%白细胞介素10%内毒素耐受
Toll樣受體4%膿毒癥%白細胞介素10%內毒素耐受
Toll양수체4%농독증%백세포개소10%내독소내수
Toll-like receptor 4%Sepsis%Interleukin-10%Endotoxin-tolerant
目的 观察不同预后重症脓毒症患者外周血单核细胞Toll样受体4(TLR4)的表达与内毒素耐受之间的关系.方法 选取35例重症脓毒症患者(重症脓毒症组)和15例健康体检者(对照组),分别在入住ICU 24 h内和体检当天用流式细胞术测定外周血单核细胞TLR4表达情况及酶联免疫吸附法测定血清肿瘤坏死因子(TNF)-α、白细胞介素(IL)-10浓度.同时分离外周血单核细胞,加入40 μg/ml脂多糖培养24h,同样测定单核细胞TLR4表达情况及细胞培养上清液TNF-α、IL-10浓度.结果 35例重症脓毒症患者死亡10例(死亡组),生存25例(生存组),28 d病死率为28.6％(10/35).重症脓毒症组外周血单核细胞TLR4表达显著低于对照组[(11.09±8.90)平均荧光强度(MFI)比(33.72±12.59) MFI],差异有统计学意义(P＜0.01)；血清TNF-α、IL-10浓度显著高于对照组[(96.66±45.33) ng/L 比(2.53±1.21) ng/L、(149.79±67.15) ng/L比(34.56±19.08) ng/L],差异有统计学意义(P＜0.01).生存组与死亡组外周血单核细胞TLR4表达比较差异无统计学意义(P＞0.05).给予脂多糖刺激后对照组外周血单核细胞TLR4表达较脂多糖刺激前明显升高[(50.22±19.23) MFI比(33.72±12.59) MFI],差异有统计学意义(P＜0.05)；生存组与死亡组脂多糖刺激后外周血单核细胞TLR4表达均明显降低[(4.55±2.30) MFI比(11.21±7.92) MFI、(5.46±3.44)MFI比(10.15±9.70) MFI],差异有统计学意义(P＜0.01).生存组与死亡组细胞培养上清液TNF-α、IL-10浓度均显著低于对照组[(22.34±8.27)、(19.49±5.35) ng/L比(88.70±34.21) ng/L,(54.29±32.89)、(98.04±40.26) ng/L比(146.56±52.18) ng/L],差异有统计学意义(P＜0.01),但死亡组IL-10浓度显著高于生存组,差异有统计学意义(P＜0.05).结论 不同预后重症脓毒症患者,均存在内毒素耐受,在内毒素耐受情况下,单核细胞分泌炎性因子的能力是不同的.
目的 觀察不同預後重癥膿毒癥患者外週血單覈細胞Toll樣受體4(TLR4)的錶達與內毒素耐受之間的關繫.方法 選取35例重癥膿毒癥患者(重癥膿毒癥組)和15例健康體檢者(對照組),分彆在入住ICU 24 h內和體檢噹天用流式細胞術測定外週血單覈細胞TLR4錶達情況及酶聯免疫吸附法測定血清腫瘤壞死因子(TNF)-α、白細胞介素(IL)-10濃度.同時分離外週血單覈細胞,加入40 μg/ml脂多糖培養24h,同樣測定單覈細胞TLR4錶達情況及細胞培養上清液TNF-α、IL-10濃度.結果 35例重癥膿毒癥患者死亡10例(死亡組),生存25例(生存組),28 d病死率為28.6％(10/35).重癥膿毒癥組外週血單覈細胞TLR4錶達顯著低于對照組[(11.09±8.90)平均熒光彊度(MFI)比(33.72±12.59) MFI],差異有統計學意義(P＜0.01)；血清TNF-α、IL-10濃度顯著高于對照組[(96.66±45.33) ng/L 比(2.53±1.21) ng/L、(149.79±67.15) ng/L比(34.56±19.08) ng/L],差異有統計學意義(P＜0.01).生存組與死亡組外週血單覈細胞TLR4錶達比較差異無統計學意義(P＞0.05).給予脂多糖刺激後對照組外週血單覈細胞TLR4錶達較脂多糖刺激前明顯升高[(50.22±19.23) MFI比(33.72±12.59) MFI],差異有統計學意義(P＜0.05)；生存組與死亡組脂多糖刺激後外週血單覈細胞TLR4錶達均明顯降低[(4.55±2.30) MFI比(11.21±7.92) MFI、(5.46±3.44)MFI比(10.15±9.70) MFI],差異有統計學意義(P＜0.01).生存組與死亡組細胞培養上清液TNF-α、IL-10濃度均顯著低于對照組[(22.34±8.27)、(19.49±5.35) ng/L比(88.70±34.21) ng/L,(54.29±32.89)、(98.04±40.26) ng/L比(146.56±52.18) ng/L],差異有統計學意義(P＜0.01),但死亡組IL-10濃度顯著高于生存組,差異有統計學意義(P＜0.05).結論 不同預後重癥膿毒癥患者,均存在內毒素耐受,在內毒素耐受情況下,單覈細胞分泌炎性因子的能力是不同的.
목적 관찰불동예후중증농독증환자외주혈단핵세포Toll양수체4(TLR4)적표체여내독소내수지간적관계.방법 선취35례중증농독증환자(중증농독증조)화15례건강체검자(대조조),분별재입주ICU 24 h내화체검당천용류식세포술측정외주혈단핵세포TLR4표체정황급매련면역흡부법측정혈청종류배사인자(TNF)-α、백세포개소(IL)-10농도.동시분리외주혈단핵세포,가입40 μg/ml지다당배양24h,동양측정단핵세포TLR4표체정황급세포배양상청액TNF-α、IL-10농도.결과 35례중증농독증환자사망10례(사망조),생존25례(생존조),28 d병사솔위28.6％(10/35).중증농독증조외주혈단핵세포TLR4표체현저저우대조조[(11.09±8.90)평균형광강도(MFI)비(33.72±12.59) MFI],차이유통계학의의(P＜0.01)；혈청TNF-α、IL-10농도현저고우대조조[(96.66±45.33) ng/L 비(2.53±1.21) ng/L、(149.79±67.15) ng/L비(34.56±19.08) ng/L],차이유통계학의의(P＜0.01).생존조여사망조외주혈단핵세포TLR4표체비교차이무통계학의의(P＞0.05).급여지다당자격후대조조외주혈단핵세포TLR4표체교지다당자격전명현승고[(50.22±19.23) MFI비(33.72±12.59) MFI],차이유통계학의의(P＜0.05)；생존조여사망조지다당자격후외주혈단핵세포TLR4표체균명현강저[(4.55±2.30) MFI비(11.21±7.92) MFI、(5.46±3.44)MFI비(10.15±9.70) MFI],차이유통계학의의(P＜0.01).생존조여사망조세포배양상청액TNF-α、IL-10농도균현저저우대조조[(22.34±8.27)、(19.49±5.35) ng/L비(88.70±34.21) ng/L,(54.29±32.89)、(98.04±40.26) ng/L비(146.56±52.18) ng/L],차이유통계학의의(P＜0.01),단사망조IL-10농도현저고우생존조,차이유통계학의의(P＜0.05).결론 불동예후중증농독증환자,균존재내독소내수,재내독소내수정황하,단핵세포분비염성인자적능력시불동적.
Objective To investigate the expression of Toll-like receptor 4 (TLR4) of peripheral blood mononuclear cell (PBMC) in the different prognosis of patients with severe sepsis and its relation with endotoxin-tolerant.Methods Thirty-five patients with severe sepsis (severe sepsis group) and 15 healthy volunteers (control group),respectively stayed in ICU 24 h and physical examination in the day measured TLR4 expression of PBMC by flow cytometry and measured the serum of tumor necrosis factor (TNF)-α and interleukin (IL)-10 by enzyme-linked immunosorbentassay.Simultaneous separation of peripheral blood of PBMC,addition of 40 μ g/ml lipopolysaccharide (LPS) cultured for 24 h,and TLR4 expression of PBMC was measured in the same manner and the culture supernatant of TNF-α and IL-10.Results Thirty-five patients with severe sepsis survivor 25 cases (survivor group) and death 10 cases (death group),28 d death rate was 28.6％ (10/35).The TLR4 expression of PBMC in severe sepsis group was significantly lower than that in control group [(11.09 ± 8.90) MFI vs.(33.72 ± 12.59) MFI,P ＜ 0.01],the serum TNF-α and IL-10 in severe sepsis group were significantly higher than those in control group [(96.66 ± 45.33) ng/L vs.(2.53 ± 1.21) ng/L,(149.79 ± 67.15) ng/L vs.(34.56 ± 19.08) ng/L,P ＜ 0.01].There was no significant difference in TLR4 expression of PBMC between survivor group and death group (P ＞ 0.05).The TLR4 expression of PBMC in control group after LPS stimulation was significantly higher than that before LPS stimulation [(50.22 ± 19.23) MFI vs.(33.72 ± 12.59) MFI,P ＜ 0.05],survivor group and death group after LPS stimulation were significantly lower than those before LPS stimulation [(4.55 ± 2.30) MFI vs.(11.21 ±7.92) M FI and (5.46 ± 3.44) M FI vs.(10.15 ± 9.70) MFI,P ＜ 0.01].The culture supernatant of TNF-α,IL-10 in survivor group and death group were significantly lower than those in control group [(22.34 ± 8.27)and (19.49 ±5.35) ng/L vs.(88.70 ±34.21) ng/L,(54.29 ±32.89) and (98.04 ±40.26) ng/L vs.(146.56 ± 52.18) ng/L,P ＜ 0.01],but the culture supernatant of IL-10 in death group was significantly higher than that in survivor group (P ＜ 0.05).Conclusion Different prognosis of patients with severe sepsis have endotoxin tolerance and different inflammatory cytokine secretion abifity.
