重症急性胰腺炎患者早期或晚期手术时外周血有核细胞Toll样受体表达差异及意义  

The change of toll-like receptor expression between early and delayed surgical treatment in severe acute pancreatitis?

作　　者：吴河水[1] 张进祥[1] 张锦辉[2] 王琳[3] 王慧[4] 王春友[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院急诊外科,武汉430022 [2]华中科技大学同济医学院附属协和医院外科实验室,武汉430022 [3]华中科技大学同济医学院附属协和医院儿科,武汉430022 [4]同济医学院遗传教研室

出　　处：《中华急诊医学杂志》2004年第10期682-684,共3页Chinese Journal of Emergency Medicine

摘　　要：目的　探讨重症急性胰腺炎患者早期或晚期手术时外周血单核细胞Toll样受体 2、 4mRNA的表达差异 ,及其与患者并发症发生率和预后的相关性。方法　随机选取重症急性胰腺炎患者 2 9例 ,分成早期或晚期手术组 ,于手术后第 5天分离外周血有核细胞 ,利用逆转录聚合酶联反应 (RT PCR)法检测TLR2、TLR4基因的变化 ,同时测量血浆内毒素水平的变化 ,并与并发症发生率和病死率的差别作相关性分析。结果　早期手术组与晚期组的病死率分别为 2 5 % (3/12 )和 5 % (1/17) ,χ2 =15 2 1,P <0 0 1;并发症发生率分别为 10 0 %和 35 % ,χ2 =5 34,P <0 0 5 ;TLR2mRNA的表达水平分别为 (119 82± 11 13)和(75 15± 6 34) (t =12 5 4 ,P <0 0 1) ;TLR4mRNA的表达水平为 (98 11± 5 16 )和 (6 5 5 4± 5 11) ,t =16 83,P <0 0 1;两组间内毒素水平分别为 (1 16± 0 10 )pg/L和 (1 0 9± 0 0 8)pg L ,t =1 83,P >0 0 5。结论　与晚期手术者比较 ,早期手术者外周血白细胞TLR4及TLR2mRNA表达水平增加 ,术后病死率和并发症发生率增加 。Objective To explore differences in the expression of toil-like receptor(TLRs) 2,4 mRNA in the peripheral white blood cells (WBC) between early and delayed surgical treatment in severe acute pancreatitis(SAP). The relationship between the expression of TLRs and incidence of complications or mortality in patients was studied.Methods Twenty-nine patients with SAP were divided into early and delayed surgical treatment groups depending on operation time. Five days after the operation,the expression of TLR2 and TLR4 mRNA in WBC was observed by method of RT-PCR,the level of serum endotoxin was measured. The incidence of complications and mortality were analyzed.Results The mortality in early and delayed surgical treatment groups were 25%(3/12) and 5%(1/19),χ 2=15.21,P<0.01;the incidence of complications were 100% and 35%,χ 2=5.34, P<0. 05. The expressions of TLR4mRNA, TLR2mRNA were 98.11±5.16 vs 65.54±5.11(t=16.8, P<0.01),and 119.82± 11.13 vs 75.15±6.34(t=12.54, P<0. 01),respectively. However, there was no significant difference in the level of endotoxin between the two groups(1.16±0.10 pg/L vs 1.09±0.08 pg/L, t=1.83, P>0.05). Conclusion The expression of TLR2, 4 mRNA is higher in the early surgical group than in the delayed surgical group,and accompanied with more complications. It indicates that early surgical treatment in patients with SAP may worsen organ dysfunction through re-inflammatory reaction.

关 键 词：晚期 患者 并发症发生率 重症急性胰腺炎 有核细胞 TLR2 早期 体表 表达差异 利用 

分 类 号：R657.5[医药卫生—外科学]