急性脑血管病引发多器官功能障碍综合征患者外周血有核细胞Toll-4受体的表达  

The expression of toll receptor-4 in patients with multiple organ dysfunction syndrome induced by acute cerebral vascular disease

作　　者：刘海波[1] 田晶[2] 赵节绪[3] 刘德新[1] 崔勇[2] 田家坤[1] 

机构地区：[1]吉林大学第二医院急救医学科,吉林省长春130041 [2]吉林大学第四医院神经内科 [3]吉林大学第一医院神经内科

出　　处：《中华急诊医学杂志》2009年第3期302-305,共4页Chinese Journal of Emergency Medicine

摘　　要：目的探讨外周血有核细胞Toll受体-4（toll like recepter-4，TLR-4）mRNA在急性脑血管病（acute cerebrovascular disease，ACVD）引发全身炎症反应综合征（systemic infammatory response syndrome,SIRS）及多器官功能障碍综合征（multiple organ dysfunction syndrome , MODS）发病过程中的表达规律以及与病情变化的相关性。方法153例急性脑血管病患者来自2005年10月至2006年3月吉林大学第一、二、四医院神经内科及ICU住院患者，于发病3d内入院，经过头部CT或MRI检查确诊。采用前瞻性研究方法，分为单纯ACVD组60例，ACVD引发SIRS组45例，ACVD引发MODS组48例，诊断标准：均符合中国第四届脑血管学术会议各类脑血管病的诊断标准。排除标准：（1）发病前两周内有过感染或炎症性疾病病史；（2）部分心脏疾患，包括急性心肌炎、急性冠状血管疾病（如急性心肌梗死、心绞痛等）及心脏瓣膜病等；（3）近期使用过激素；（4）恶性肿瘤、自身免疫系统疾病、肝脏、肾脏、血液疾病等。采用逆转录酶聚合酶链反应测定急性脑血管病患者外周血有核细胞TLR-4 mRNA表达。两组间比较采用t检验，多组间比较采用单因素方差分析，多组间两两比较采用q检验。结果患者发病第3日TLR-4 mRNA表达明显升高；对于TLR-4 mRNA的表达，ACVD引发SIRS组与单纯ACVD组相比（P〈0．01），ACVD引发MODS组与ACVD引发SIRS组相比较（P〈0．01），而且其表达升高的程度随着病情的加重而呈升高趋势；MODS积分越高，TLR-4 mRNA的表达也越高，且P〈0．01；ACVD引发MODS患者中，死亡组与存活组相比较，死亡组的血清TLR-4 mRNA的表达明显高于存活组（P〈0．01）。结论ACVD这一外源性非感染疾病可以引发SIRS和MODS的机制可能与机体过度免疫应答有关。Objective To study the expression of toll receptor-4 in patients with systemic infammatory response syndrome （SIRS）and multiple organ dysfunction syndrome （MODS） induced by acute cerebral vascular disease （ACVD）. Method Totally 153 ACVD patients, admitted to Departments of Neurology Medicine and ICU of the First, the Second and the Forth Hospitals of Jilin University from October 2005 to March 2006, were enrolled in this study. The patients were admitted to the hospitals within 3 days after onset, and were confirmed by CT or MRI. The 153 patients in the prospective study was divided into three groups： ACVD group （ n = 60）, SIRS group induced by ACVD （ n = 45）, MODS group induced by ACVD （ n = 48）. The diagnosis criteria accorded with the criterion set by the Forth Conference of Cerebrovaseular Disease in China. The exclusion criterion included： ①patients with infection or inflammatory disease two weeks before the onset of AVCD ; ② patients with cardiac disease, including acute myocarditis, acute myocardial infarction, angina episodes, degenerative calcific valvular disease,and so on;③ patients with use of hormone recently;④ malignant tumor, autoimmunity system disease, liver disease, kidney disease and hematologic disease. The expression of TLR-4 mRNA gene of the nucleated cell in the peripheral blood in the ACVD patients was measured by using RT-PCR. Statistics methods of t test, q test and simplex factor analysis of variance have been used Statistical analysis was carried out by using T-test, one-way analysis of variances, and q-test. Results The expression of TLR-4mRNA obviously increased on the third day after onset of AVCD. Compared with ACVD group, the expression of TLR-4mRNA in SIRS group was significantly higher （0.61 ± 0. 13 vs. 0.98 ± 0.15, P 〈 0.01）. Compared with SIRS group, the expression of TLR-4mRNA in MODS group was significantly higher （0.98 ± 0.15 vs. 1.32 ± 0.38, P 〈 0. 01 ）. The expression of TLR-4mRNA had a increasing tendency with the sever

关 键 词：急性脑血管病 多器官功能障碍综合征 全身发症反应综合征 Toll受体-4 

分 类 号：R743.3[医药卫生—神经病学与精神病学]