扶正利肺汤对老年社区获得性肺炎患者中性粒细胞TLRs及MyD88 mRNA表达研究  

The role of FuZhengLiFei decoction in expression of TLRs and MyD88 mRNA of neutrophil from community acquired pneumonia in the elderly

作　　者：林闽加[1] 李红强[1] 程婷婷[1] 许淑敏[1] 张斗霞[1] 白建文[1] 

机构地区：[1]同济大学附属东方医院急危重病科,上海200120

出　　处：《中华临床医师杂志（电子版）》2013年第19期28-33,共6页Chinese Journal of Clinicians(Electronic Edition)

基　　金：浦东新区科技发展基金创新资金(PKJ2010-Y20);上海市科学技术委员会科研计划项目课题-中药现代化专项项目(09dz1972400)

摘　　要：目的观察扶正利肺汤对老年社区获得性肺炎患者外周血中性粒细胞Toll样受体(TLRs)2、4,髓样分化因子88(MyD88)mRNA表达及对细胞因子的调节作用和临床疗效。方法以老年肺炎患者(中西医结合治疗组A,n=38,抗生素治疗组B,n=32)和对照者C组(n=25)作为研究对象。分离外周血中性粒细胞,提取中性粒细胞mRNA,实时定量-PCR检测各组TLR2,TLR4及MyD88 mRNA表达;采用ELISA检测外周血上清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)浓度并观察临床表现。结果对照组外周血中性粒细胞有基础的TLR2、TLR4和MyD88 mRNA表达和外周血TNF-α、IL-6产生,分别是0.812±0.227,0.021±0.017,0.948±0.082和(9.520±3.009)pg/ml,(28.820±8.172)pg/ml;而老年肺炎(A组、B组)患者以上指标均显著升高,A组分别是1.096±0.181,0.039±0.023,1.031±0.088和(25.810±6.737)pg/ml,(65.660±21.296)pg/ml;B组分别是1.061±0.226,0.037±0.022,1.029±0.072和(26.160±7.349)pg/ml,(65.960±19.586)pg/ml,较对照组比较差异有统计学意义(P<0.05)。两组治疗后均使TLR2、TLR4和Myd88 mRNA相对表达量下降,虽然无统计学差异,但A组治疗后TLR2 mRNA和TLR4 mRNA降低趋势更明显,P均<0.10;两组(A组、B组)治疗后TNF-α和IL-6浓度均显著下降,TNF-α分别为(15.050±3.925)pg/ml,(16.250±3.320)pg/ml,IL-6分别为(39.900±1.634)pg/ml,(40.610±1.836)pg/ml,治疗前后比较差异有统计学意义,分别为t=4.254、3.816、3.734、4.007,P=0.002、0.004、0.005、0.003;治疗后两组比较差异无统计学意义(P=0.470,P=0.372);但A组发热持续时间显著缩短,差异有统计学意义(t=5.018,P=0.001);肺部炎症吸收更明显,差异有统计学意义(χ2=4.119,P=0.042);同时抗生素治疗时间亦缩短,差异亦有统计学意义(t=3.003,P=0.008)。结论中性粒细胞TLR2、TLR4-MyD88信号传导通路在老年社区获得性肺炎发生发展中起一定作用。虽然扶正利肺汤单独治疗尚不能影响患者中性粒细胞TLR2、TLR4-Myd88 mRNA的表达及细�Objective To investigate whether FuZhengLiFei decoction could have a role in regulating expression of Toll like receptors （TLRs） 2, 4 and myeloid differentiation factor 88 （MyD88） mRNA of peripheral neutrophils and cytokones and clinical effect in olderly patients from pneumonia. Methods Elderly patients with pneumonia （treatment group A of combination of Chinese and Western medicine, n=38; treatment group B of antibiotics, n=32） and control group C （n----25） were selected as research subjects. Neutrophils isolated from patients and controls and neutrophils mRNA extracted. Expression of TLR2, TLR4 and MyD88 mRNA were measured by Real-time PCR. Cytokines （TNF-a and IL-6） in serum were also tested by ELISA and clinical manifestations were observed. Results Peripheral neutrophils of control group have a foundation ofTLR2, TLR4 and MyD88 mRNA expression and production of TNF-a, IL-6, the results were 0.812±0.227, 0.021＋±0.017, 0.948±0.082 and （9.520±3.009） pg/ml, （28.820±8.172） pg/ml respectively and elderly patients with pneumonia were significantly elevated above indicators, group A were 1.096±0.181, 0.039±0.023, 1.031±0.088 and （25.810±6.737）pg/ml, （65.660±21.296） pg/ml respectively and group B were 1.061±0.226, 0.037±0.022, 1.029±0.072 and （26.160±7.349）pg/ml, （65.960± 19.586） pg/ml. Compared with control group, difference was statistically significant （P values were less than 0.05）. After treatment, TLR2, TLR4 and MyD88 mRNA relative expression were declined in both of treatment group, but no statistically significant difference and a decreasing trends was more obvious in group A （P values were less than 0.1）. TNF-a and IL-6 levels were significantly decreased after both treatment（A, B）, they were （15.050±3.925）, （16.250±3.320）pg/rnl and （39.900±1.634） pg/ml, （40.610±1.836） pg/ml respectively （t=4.254, 3.816, 3.734, 4.007, P=0.002, 0.004, 0.005, 0.003）, but compared with no significant difference after both treatment

关 键 词：肺炎 TOLL样受体2 Toll样受体4 髓样分化因子88 扶正利肺汤 

分 类 号：R259[医药卫生—中西医结合]