潜隐性弓形虫感染通过激活TLR-4加重老年脓毒症患者凝血功能和肾功能损伤  

Latent Toxoplasma infection aggravates coagulation and renal dysfunction in elderly patients with sepsis by activating TLR-4

作　　者：沈丽娟[1] 周永华[2] 吴锡平[1] 戴红红 邢清敏 SHEN Lijuan;ZHOU Yonghua;WU Xiping;DAI Honghong;XING Qingmin(Department of ICU,Wuxi Hospital of Traditional Chinese Medicine,Wuxi,Jiangsu,214071,China;Key Laboratory of National Health Commission on Parasitic Disease Control and Prevention,Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology,Jiangsu Institute of Parasitic Diseases)

机构地区：[1]无锡市中医医院重症医学科,江苏无锡214071 [2]国家卫生健康委员会寄生虫病预防与控制技术重点实验室江苏省寄生虫与媒介控制技术重点实验室江苏省血吸虫病防治研究所

出　　处：《临床急诊杂志》2022年第9期614-619,共6页Journal of Clinical Emergency

基　　金：无锡市卫健委中青年医疗卫生拔尖人才资助计划(No:BJ2020067);无锡市卫生计生委“无锡市青年医学重点人才”项目(No:QNRC019)。

摘　　要：目的:观察潜隐性弓形虫感染对老年脓毒症患者凝血功能和肾功能的影响,并探讨其可能的机制。方法:收集2015年1月—2019年12月入住无锡市中医医院重症医学科的92例老年脓毒症患者,根据弓形虫血清学IgG抗体是否阳性分为弓形虫阳性组(21例)和弓形虫阴性组(71例)。记录入院时APACHEⅡ评分、SOFA评分。观察两组患者血小板计数、凝血功能(PT、APTT、纤维蛋白原)、肾功能水平、休克的发生率及28 d病死率情况。检测两组患者血清炎症细胞因子(TLR-4、TNF-α、IL-6),分析炎症细胞因子与凝血功能、肾功能的相关性。结果:弓形虫阳性组入院时APACHEⅡ评分、SOFA评分高于弓形虫阴性组,差异有统计学意义(均P<0.05);弓形虫阳性组感染性休克发生率[85.7%(18/21)vs.63.4%(45/71)]及28 d病死率明显升高[57.1%(12/21)vs.28.2%(20/71)]。弓形虫阳性组的脓毒症患者血小板计数较弓形虫阴性组低,但差异无统计学意义(P>0.05);弓形虫阳性组PT、APTT水平与阴性组之间差异无统计学意义(均P>0.05);弓形虫阳性组纤维蛋白原水平较阴性组明显升高,差异有统计学意义(P<0.05);弓形虫阳性组血肌酐水平较阴性组升高,差异有统计学意义(P<0.05);血肌酐水平与血小板计数呈负相关(r=-0.3447,P=0.0008)、与纤维蛋白原水平呈正相关(r=0.2309,P=0.0268)。弓形虫阳性组患者炎症细胞因子TLR-4、TNF-α、IL-6水平较弓形虫阴性组明显升高,差异有统计学意义(均P<0.05)。进一步分析发现血清TLR-4水平与APACHEⅡ评分呈正相关(r=0.2721,P=0.0087)、与SOFA评分亦呈正相关(r=0.7589,P<0.01);血清TLR-4水平与纤维蛋白原水平呈正相关(r=0.2167,P=0.0038)、与血肌酐水平呈正相关(r=0.2280,P=0.0288)。结论:潜隐性弓形虫感染通过激活TLR-4,诱导炎症因子过度表达促进有害的全身性炎症反应及凝血功能紊乱,导致老年脓毒症患者肾脏损害及不良预后。Objective:To observe the effect of latent Toxoplasma infection on coagulation and renal function in elderly patients with sepsis and explore its possible mechanism.Methods:The medical records of patients diagnosed with sepsis in ICU of Wuxi Hospital Affiliated to Nanjing University of Chinese Medicine from January 2015 to December 2019 were retrospectively analyzed.Patients were divided into positive group and negative group according to the serological antibody IgG of Toxoplasma gondii.Coagulation,platelet and renal function,incidence of shock and 28 days mortality were observed.The serum inflammatory cytokines(TLR-4,TNF-α,IL-6)and coagulation function(PT,APTT,fibrinogen)of the two groups were detected,and the correlation between inflammatory cytokines and coagulation function and renal function were analyzed.Results:A total of 92 elderly patients with sepsis were collected,of which 21 were serologically positive and 71 were serologically negative.The APACHEⅡscore and SOFA score of positive group were higher than those of negative group(all P<0.05).The incidence of septic shock and 28 days mortality were also significantly increased than the patients of negative group(18/21,85.7%vs.45/71,63.4%;12/21,57.1%vs.20/71,28.2%).The platelet count of positive group had a downward trend than those of negative group,but there was no statistical difference(P>0.05).The PT and APTT levels of the positive group had no difference than the patients of negative group(all P>0.05);the fibrinogen level of the positive group was significantly higher than that of the negative group(P<0.05);The serum creatinine level in patients of positive group was higher than the patients of negative group(P<0.05).There was a negative correlation between serum creatinine level and platelet count(r=-0.3447,P=0.0008),and there was a positive correlation between serum creatinine level and fibrinogen(r=0.2309,P=0.0268).The serum inflammatory cytokines such as TLR-4,TNF-αand IL-6 were significantly higher than that of the negative group(all P<0.05).F

关 键 词：潜隐性弓形虫感染 TLR-4 脓毒症 凝血功能 肾功能 

分 类 号：R382.5[医药卫生—医学寄生虫学]