新生儿和婴幼儿手术应激后外周血单核细胞Toll样受体水平变化及临床意义  

Toll-like receptor changes and its clinical significance in peripheral blood mononuclear cells in neonates and infants under surgical stress

作　　者：黄志见[1] 汪健[1] 强红家[1] 潘江[1] 朱明清 耿美菊 陈黎 

机构地区：[1]苏州大学附属儿童医院小儿外科,江苏苏州215003 [2]江苏省血液研究所,江苏苏州215003

出　　处：《临床儿科杂志》2010年第11期1079-1082,共4页Journal of Clinical Pediatrics

基　　金：江苏省卫生厅重大科研课题(No.K200509)

摘　　要：目的探讨新生儿、婴幼儿手术应激后外周血单核细胞Toll样受体(TLR)2、4表达变化规律及临床意义。方法选择择期手术患儿32例,包括新生儿组9例,婴幼儿组23例,分别于术前、术后、术后1天、3天、7天采集外周血2 ml肝素抗凝。采用流式细胞术检测单核细胞表面TLR2、4的水平;分离外周血单核细胞,用LPS刺激后,ELISA法测定上清液中TNF-α和IL-6的水平。结果新生儿组和婴幼儿组术后TLR2和TLR4表达均明显降低,与术前比较差异有统计学意义(P<0.05),术后1天均恢复正常(P>0.05)。LPS刺激的TNF-α水平术后明显抑制,术后1天逐渐上升;IL-6水平无明显变化。结论手术创伤早期可致TLR2和TLR4表达下调,导致机体对病原微生物的敏感性下降。Objective To examine Toll-like receptor 2（TLR2） and Toll-like receptor 4（TLR4） expression in monocytes in neonates and infants under surgical stress and to study its clinical significance.Methods A total 32 patients were divided into neonate group（n = 9） and infant group（n = 23）.Samples of 2 ml peripheral blood were obtained and heparinized before operation,at the end of operation,and 1,3,7 days after operation.（1） TLR2 and TLR4 expressions on peripheral blood mononuclear cells（PBMCs） were analyzed by flow cytometry.（2） PBMCs were isolated and stimulated with LPS.Concentrations of IL-6 and TNFα in the PBMC culture supernatants were measured with enzyme-linked immunosorbent assay.Results（1） TLR2 and TLR4 expressions in the neonate group significantly decreased at the end of the operation（P 0.05）,and then returned to preoperative level on postoperative day 1（P 0.05）.TLR2 and TLR4 expressions significantly decreased in the infant group at the end of the operation（P 0.05）,and then returned to preoperative levels on postoperative day 1（P 0.05）.（2） TNFα was significantly suppressed at the end of the operation after stimulated with LPS and showed gradual increment on postoperative day 1 and IL-6 showed no significant change.Conclusions Early-stage surgical insults can down-regulate TLR2 and TLR4 expressions on peripheral blood mononuclear cells,thus suppressing immune responses to microbial pathogens.

关 键 词：TOLL样受体2 TOLL样受体4 手术 流式细胞术 

分 类 号：R726.5[医药卫生—儿科]