重症儿童感染性休克外周血单个核细胞TLRs信号通路及细胞免疫炎症因子水平变化  

Changes of TLRs signaling pathway in peripheral blood mononuclear cells and cellular immune inflammatory factors in children with severe septic shock

作　　者：桂冬梅 尹杨艳 陈丹丹 蔡昌君 严灵丽 黄惠敏 阎青青 GUI Dong-mei;YIN Yang-yan;CHEN Dan-dan;CAI Chang-jun;YAN Ling-li;HUANG Hui-min;YAN Qing-qing(The First Affliated Hospital of Hainan Medical College,Haikou,Hainan 570100,China)

机构地区：[1]海南医学院第一附属医院儿科,海南海口570100

出　　处：《中华医院感染学杂志》2022年第23期3648-3652,共5页Chinese Journal of Nosocomiology

基　　金：海南省自然科学基金资助项目(819MS122)。

摘　　要：目的分析重症儿童感染性休克外周血单个核细胞(PBMC)Toll样受体(TLRs)信号通路及细胞免疫炎症因子水平变化。方法选取2019年1月-2020年4月海南医学院第一附属医院收治的90例重症感染性休克患儿作为研究组,另选择同期体检的健康儿童60名作为对照组;同时根据28 d预后情况将研究组患儿分为生存组(n=54)和死亡组(n=36),分析重症感染性休克患儿病原菌分布,比较外周血PBMC的Toll样受体(TLR)2、TLR4、核因子κB(NF-κB)mRNA表达及肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6、IL-8水平和免疫功能指标,采用受试者工作特征曲线(ROC曲线)分析其对重症感染性休克的预测价值。结果共培养出病原菌106株,革兰阴性菌占69.81%。研究组TLR2、TLR4、NF-κB mRNA表达及TNF-α、IL-6、IL-8水平高于对照组,CD_(3)^(+)、CD_(4)^(+)/CD_(8)^(+)低于对照组(P<0.05)。ROC曲线显示,TLR2、TLR4、NF-κB mRNA表达及TNF-α、IL-6、IL-8、CD_(3)^(+)、CD_(4)^(+)/CD_(8)^(+)对重症感染性休克诊断价值较高(P<0.05)。治疗后研究组TLR2、TLR4、NF-κB mRNA表达及TNF-α、IL-6、IL-8水平低于治疗前,CD_(3)^(+)、CD_(4)^(+)/CD_(8)^(+)高于治疗前(P<0.05)。死亡组TLR2、TLR4、NF-κB mRNA表达及TNF-α、IL-6、IL-8高于生存组,CD_(3)^(+)、CD_(4)^(+)/CD_(8)^(+)低于生存组(P<0.05)。结论重症感染性休克患儿以革兰阴性菌感染为主,其PBMC表面TLR2、TLR4、NF-κB表达及TNF-α、IL-6、IL-8水平呈高表达,CD_(3)^(+)、CD_(4)^(+)/CD_(8)^(+)呈低表达,可评估重症感染性休克和预后。OBJECTIVE To analyze the changes of Toll-like receptors(TLRs)signaling pathway in peripheral blood mononuclear cells(PBMC)and cellular immune inflammatory factors in children with severe septic shock.METHODS Ninety children with severe septic shock admitted to the First Affiliated Hospital of Hainan Medical College from Jan 2019 to Apr 2020 were recruited as the study group.And 60 healthy children were in the control group.According to the prognosis on day 28,children in the study group were divided into the survival group(n=54)and death group(n=36)and the distribution of pathogenic bacteria among the patients was analyzed.The mRNA expression levels of Toll-like receptor 2(TLR2),Toll-like receptor 4(TLR4)and nuclear factor kappa B(NF-κB)in peripheral blood PBMC,the levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-8(IL-8)and immune function indicators between the groups were compared.The predictive value of above indicators for severe septic shock was analyzed by using the receiver operating characteristic(ROC)curve analysis.RESULTS A total of 106 strains were isolated,in which Gram-negative bacteria accounted for 69.81%.The mRNA expression of TLR2,TLR4 and NF-κB,the levels of TNF-α,IL-6 and IL-8 in the study group were higher than those in the control group,while CD_(3)^(+)and CD_(4)^(+)/CD_(8)^(+)were lower than those in the control group(P<0.05).ROC curve analysis showed that mRNA expression of TLR2,TLR4 and NF-κB,TNF-α,IL-6,IL-8,CD_(3)^(+)and CD_(4)^(+)/CD_(8)^(+)had high value in the diagnosis of severe septic shock(P<0.05).After treatment,the mRNA expression of TLR2,TLR4 and NF-κB,the levels of TNF-α,IL-6 and IL-8 in the study group reduced,while CD_(3)^(+)and CD_(4)^(+)/CD_(8)^(+)increased(P<0.05).The mRNA expression of TLR2,TLR4 and NF-κB,the levels of TNF-α,IL-6 and IL-8 in the death group were higher than those in the survival group,while CD_(3)^(+)and CD_(4)^(+)/CD_(8)^(+)were lower than those in the survival group(P<0.05).CONCLUSION Children with severe septic shock a

关 键 词：重症儿童感染性休克 单个核细胞TLRs信号通路 炎症因子水平 免疫功能 

分 类 号：R725.9[医药卫生—儿科]