老年重症肺部感染患者T细胞亚群和TLR4/NF-κB蛋白表达及其与预后的关系  

Expression of T cell subsets and TLR4/NF-κB in elderly patients with severe pulmonary infection and their relationship with prognosis

作　　者：杨婷婷[1] 周瑞祥[1] 彭丽清[1] 王丽[1] 姚慧[1] YANG Ting-ting;ZHOU Rui-xiang;PENG Li-qing;WANG Li;YAO Hui(The First Hospital of Wuhan,Wuhan,Hubei 430022,China)

机构地区：[1]武汉市第一医院重症医学科,湖北武汉430022

出　　处：《中华医院感染学杂志》2021年第17期2668-2672,共5页Chinese Journal of Nosocomiology

基　　金：湖北省医药卫生科研基金资助项目(WJ2015MB240);湖北省武汉市临床医学科研基金资助项目(WX15A09)。

摘　　要：目的分析老年重症肺部感染(SPI)患者T细胞亚群和Toll样受体4/核因子κB(TLR4/NF-κB)蛋白表达变化及其与预后之间的关系。方法选择2017年6月-2020年8月武汉市第一医院重症医学科(ICU)收治的178例老年SPI患者为研究组,同期178例老年非肺部感染患者为对照组。比较两组患者T细胞亚群CD_(3)^(+)、CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+)表达,炎症指标白细胞计数(WBC)、血清C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6水平,外周血单个核细胞TLR4/NF-κB信号通路蛋白表达,并分析上述指标与老年SPI患者预后的关系。结果研究组T细胞亚群CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)水平均低于对照组(P<0.05),WBC、CRP、TNF-α和IL-6水平均高于对照组(P<0.05),外周血单个核细胞TLR4蛋白、NF-κB蛋白和p-IκB蛋白表达均高于对照组(P<0.05);178例老年SPI患者住院治疗后死亡52例、存活126例,入院第7天,死亡组T细胞亚群CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)水平低于存活组(P<0.05),WBC、CRP、TNF-α和IL-6水平高于存活组(P<0.05),外周血TLR4蛋白、NF-κB蛋白和p-IκB蛋白表达均高于存活组(P<0.05)。结论老年SPI患者的免疫功能下降,TLR4/NF-κB蛋白表达升高,且其水平变化与患者的预后不良有关。OBJECTIVE To observe the changes of expression of T cell subsets and Toll-like receptor 4/nuclear factorκB(TLR4/NF-κB)in elderly patients with severe pulmonary infection(SPI)and analyze their relationship with prognosis.METHODS A total of 178elderly patients with SPI who were treated in intensive care unit(ICU)of the First Hospital of Wuhan from Jun 2017to Aug 2020were assigned as the study group,meanwhile,178elderly patients with non-pulmonary infection were set as the control group.The expression levels of T cell subsets CD_(3)^(+),CD_(4)^(+),CD_(8)^(+),CD_(4)^(+)/CD_(8)^(+),inflammatory factors white blood cell(WBC),serum C-reactive protein,tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)were compared between the two groups of patients,the expression of TLR4/NF-κB signaling pathways in peripheral blood mononuclear cells was detected,and the relationship between the above indexes and the prognosis of the elderly patients with SPI was observed.RESULTS The levels of T cell subsets CD_(3)^(+),CD_(4)^(+)and CD_(4)^(+)/CD_(8)^(+)of the study group were significantly lower than those of the control group(P<0.05);the levels of WBC,CRP,TNF-αand IL-6of the study group were significantly higher than those of the control group(P<0.05).The expression levels of peripheral blood mononuclear cells TLR4protein,NF-κB protein and p-IκB protein of the study group were significantly higher than those of the control group(P<0.05).Of the 178elderly patients with SPI who were hospitalized for treatment,52died,126survived.The levels of T cell subsets CD_(3)^(+),CD_(4)^(+)and CD_(4)^(+)/CD_(8)^(+)of the death group were significantly lower than those of the survival group after the admission for 7days(P<0.05),the levels of WBC,CRP,TNF-αand IL-6of the death group were significantly higher than those of the survival group(P<0.05),and the expression levels of peripheral blood TLR4protein,NF-κB protein and p-IκB protein of the death group were significantly higher than those of the survival group(P<0.05).CONCLUSION The immu

关 键 词：重症肺部感染 免疫功能 Toll样受体4/核因子κB 

分 类 号：R563.1[医药卫生—呼吸系统]