自发性细菌性腹膜炎血清PCT和TLR4/MyD88/NF-κB信号通路表达及意义  

Expression of serum PCT and TLR4/MyD88/NF-κB signaling pathways in patients with spontaneous bacterial peritonitis and clinical significance

作　　者：魏淑琴 宗晓 张俊英[3] 石琳 李淑秀[2] WEI Shu-qin;ZONG Xiao;ZHANG Jun-ying;SHI Lin;LI Shu-xiu(Qingdao Traditional Chinese Medicine Hospital(Qingdao Haici Hospital),Qingdao,Shandong 266033,China)

机构地区：[1]青岛市中医医院(青岛市海慈医院)养生保健查体中心,山东青岛266033 [2]青岛市中医医院(青岛市海慈医院)血液净化中心,山东青岛266033 [3]青岛市中医医院(青岛市海慈医院)儿科,山东青岛266033 [4]青岛市中医医院(青岛市海慈医院)小儿内科,山东青岛266033

出　　处：《中华医院感染学杂志》2022年第13期1936-1940,共5页Chinese Journal of Nosocomiology

基　　金：山东省自然科学基金资助项目(20201956)。

摘　　要：目的探究肝硬化失代偿期自发性细菌性腹膜炎(SBP)患者血清降钙素原(PCT)和Toll样受体4(TLR4)/髓样分化因子88(MyD88)/核转录因子κB(NF-κB)信号通路表达及临床意义。方法选取2018年3月-2021年3月青岛市海慈医院收治的102例肝硬化失代偿期患者,根据是否临床诊断为SBP,分为SBP组29例和非SBP组73例,比较两组一般资料、临床评分[Child-Turcotte-Pugh评分(CTP评分)和终末期肝病模型(MELD)评分]及血清炎症指标(PCT、TLR4、MyD88、NF-κB),采用多因素Logistic回归分析探究SBP发生影响因素,绘制受试者工作特征曲线(ROC)探究血清PCT、TLR4、MyD88、NF-κB对SBP诊断价值。结果SBP组患者并发症数≥2的例数、总胆红素(TBIL)水平、国际标准化比值(INR)、CTP评分、MELD评分、血清PCT、TLR4、MyD88及NF-κB表达均较非SBP组升高(P<0.05)。多因素Logistic回归分析显示,CTP评分、MELD评分是肝硬化失代偿期患者发生SBP的危险因素(P<0.05)。PCT、TLR4、MyD88及NF-κB诊断SBP的ROC曲线下面积分别为0.915、0.855、0.839、0.735。结论肝硬化失代偿期SBP患者血清PCT、TLR4、MyD88及NF-κB表达明显升高,早期检测血清PCT、TLR4、MyD88及NF-κB表达对SBP有一定诊断价值。OBJECTIVE To explore the expression of serum procalcitonin(PCT)and Toll-like receptor 4(TLR4)/myeloid differentiation factor 88(MyD88)/nuclear factor-κB(NF-κB)signaling pathways in decompensated liver cirrhosis patients with spontaneous bacterial peritonitis(SBP).METHODS A total of 102 patients with decompensated liver cirrhosis who were treated in Qingdao Haici Hospital from Mar 2018 to Mar 2021 were enrolled in the study and divided into the SBP group with 29 cases and the non-SBP group with 73 cases according to the clinical diagnosis of SBP.The baseline data,clinical scores[Child-Turcotte-Pugh score(CTP score)and model for end-stage liver disease(MELD)score]and serum inflammatory indexes(PCT,TLR4,MyD88,NF-κB)were compared between the two groups.Multivariate logistic regression analysis was performed for influencing factors for SBP,and receiver operating characteristic(ROC)curves were drawn to explore the values of serum PCT,TLR4,MyD88 and NF-κB in diagnosis of SBP.RESULTS The number of cases with no less than 2 types of complications,total bilirubin(TBIL)level,international normalized ratio(INR),CTP score,MELD score,and expression levels of serum PCT,TLR4,MyD88 and NF-κB were significantly higher in the SBP group than in the non-SBP group(P<0.05).Multivariate logistic regression analysis showed that CTP score and MELD score were the risk factors for SBP in the patients with decompensated liver cirrhosis(P<0.05).The areas under ROC curves of PCT,TLR4,MyD88 and NF-κB were respectively 0.915,0.855,0.839 and 0.735 in diagnosis of SBP.CONCLUSION The expression levels of serum PCT,TLR4,MyD88 and NF-κB of the decompensated liver cirrhosis patients complicated with SBP are remarkably elevated,and the detection of serum PCT,TLR,MyD88 and NF-κB in early stage has certain value in diagnosis of SBP.

关 键 词：肝硬化 自发性腹膜炎 降钙素原 Toll样受体4 髓样分化因子88 核转录因子ΚB 

分 类 号：R572.2[医药卫生—消化系统]