外周血单核细胞Toll样受体/核转录因子-κB信号通路分子表达水平与血液透析合并血液感染患者病情严重程度相关性分析  

Correlation between expression levels of TLRs/NF-κB signaling pathway molecules in peripheral blood mononuclear cells and disease severity of patients with hemodialysis and bloodstream infection

作　　者：王浩 高春美 WANG Hao;GAO Chunmei(Department of Emergency Medicine,Zibo 148 Hospital,Zibo 255300,China)

机构地区：[1]淄博一四八医院急诊科,山东淄博255300

出　　处：《陕西医学杂志》2023年第7期875-879,共5页Shaanxi Medical Journal

基　　金：山东省自然科学基金资助项目(ZR2015HK051)。

摘　　要：目的:研究血液透析(HD)合并导管相关血液感染(CRBSI)患者外周血单核细胞Toll样受体(TLR4)/核转录因子-κB(NF-κB)信号通路激活情况及其与病情严重程度的相关性。方法:选取HD治疗期间发生CRBSI的患者82例(CRBSI组)和单纯HD患者83例(HD组)为样本,详细采集临床资料并检测外周血单核细胞TLR4和NF-κB表达水平以及血清白介素-4(IL-4)、IL-6和肿瘤坏死因子-α(TNF-α)水平并进行比较,根据分级诊断标准将HD合并CRBSI患者分为休克组23例和非休克组59例并按指南进行治疗,同时随访28 d病死率并根据结果将患者分为死亡组17例和存活组65例,分析TLR4/NF-κB信号通路与HD合并CRBSI患者病情严重程度的关系。结果:CRBSI组急性生理学与慢性健康状况评分(APACHEⅡ)、外周血单核细胞TLR4和NF-κB表达水平以及血清IL-4、IL-6和TNF-α水平高于HD组,差异有统计学意义(均P<0.05);休克组外周血单核细胞TLR4和NF-κB表达水平以及血清IL-4、IL-6和TNF-α水平高于非休克组,病死组外周血单核细胞TLR4和NF-κB表达水平以及血清IL-4、IL-6和TNF-α水平高于存活组,差异有统计学意义(均P<0.05);HD合并CRBSI患者外周血单核细胞TLR4和NF-κB表达水平及血清IL-4、IL-6和TNF-α水平与APACHEⅡ评分呈明显正相关性(均P<0.05)。结论:TLR4/NF-κB信号通路激活和炎症因子大量表达与HD合并CRBSI患者发病和进展存在密切联系,对评估病情严重程度和患者预后具有良好参考价值。Objective:To study the activation of Toll-like receptor(TLR4)/nuclear factor-κB(NF-κB)signaling pathway in peripheral blood mononuclear cells of patients with hemodialysis(HD)and catheter-related bloodstream infection(CRBSI)and its correlation with disease severity.Methods:A total of 82 patients with CRBSI(CRBSI group)and 83 patients with simple HD(HD group)who underwent HD treatment were selected as samples,and the clinical data were collected in detail,and the expression levels of TLR4 and NF-κB in peripheral blood mononuclear cells and the levels of serum interleukin4(IL-4),IL-6 and tumor necrosis factorα(TNF-α)were detected and compared.According to the grading diagnostic criteria,patients with HD and CRBSI were divided into shock group(23 cases)and non-shock group(59 cases),and they proceeded treatment according to the guidelines.28-day mortality rate was followed up and the patients were divided into death group(17 cases)and survival group(65 cases),and the relationship between TLR4/NF-κB signaling pathway and severity of HD with CRBSI was analyzed.Results:The APACHEⅡscore,expression levels of TLR4 and NF-κB in peripheral blood mononuclear cells and the levels of serum IL-4,IL-6 and TNF-αin CRBSI group were higher than those in HD group(all P<0.05).The expression levels of TLR4 and NF-κB in peripheral blood mononuclear cells and the levels of serum IL-4,IL-6 and TNF-αwere higher in shock group than those in non-shock group,and the levels of above indicators in death group were higher than those in survival group(all P<0.05).The expression levels of TLR4 and NF-κB in peripheral blood mononuclear cells and levels of serum IL-4,IL-6 and TNF-αof patients with HD complicated with CRBSI were significantly positively correlated with APACHEⅡscore(all P<0.05).Conclusion:The activation of TLR4/NF-κB signaling pathway and the high expressions of inflammatory factors are closely related to the onset and progression of patients with HD and CRBSI,and they have a good reference value for assessing the dis

关 键 词：血液透析 血流感染 脓毒症 信号通路 单核细胞 TOLL样受体 核转录因子-ΚB 

分 类 号：R63[医药卫生—外科学]