重症感染性休克外周血单个核细胞TLRs信号通路变化  

Changes of TLRs signaling pathways in peripheral blood mononuclear cells of patients with severe septic shock

作　　者：吴若君 范学朋[1] 高媛媛[1] 杨秀红 胡述立[1] 熊蓉 卢蓉[1] WU Ruo-jun;FAN Xue-peng;GAO Yuan-yuan;YANG Xiu-hong;HU Shu-li;XIONG Rong;LU Rong(Wuhan No.1 Hospital,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》2024年第13期1939-1943,共5页Chinese Journal of Nosocomiology

基　　金：湖北省知识创新专项(自然基金)基金资助项目(2018CFB353)。

摘　　要：目的 探究重症感染性休克患者外周血单个核细胞(PBMCs)Toll样受体(TLRs)信号通路及细胞免疫炎症因子变化。方法选取2017年1月一2021年1月武汉市第一医院收治的101例重症感染性休克患者为研究组,根据患者人住重症监护病房(ICU)后28d内预后情况分为病死组33例和生存组68例,另外选取同期体检的120名健康体检者为对照组,采集重症感染性休克患者感染部位分泌物及血液标本进行病原菌鉴定,比较研究组和对照组以及病死组和生存组PBMCs中TLRs信号通路相关因子TLR2mRNA、TLR4mRNA、核因子κB(NF-κB)表达、外周血T淋巴细胞亚群以及炎症因子水平差异。结果101例重症感染性休克患者共分离得到病原菌117株,其中革兰阴性菌占68.38%;研究组PBMCs中TLR2mRNA、TLR4mRNA、NF-κB表达及外周血CD_(4)^(+)、白细胞介素-4(IL-4)、肿瘤坏死因子-α(TNF-α)水平高于对照组(P<0.05),CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)、IL-10、干扰素-γ(IFN-γ)水平低于对照组(P<0.05);病死组PBMCs中TLR2mRNA、TLR4mRNA、NF-κB表达及外周血CD_(8)^(+)、IL-4、TNF-α水平高于生存组(P<0.05),CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)、IL-10、IFN-γ水平低于生存组(P<0.05)。结论重症感染性休克感染的病原菌以革兰阴性菌为主,TLRs信号通路异常激活、免疫抑制以及炎症反应加重与重症感染性休克及其预后密切相关。OBJECTIVE To explore the changes of Toll-like receptors(TLRs)signaling pathways and cellular im-mune inflammatory factors in peripheral blood mononuclear cells(PBMCs)of the patients with severe septic shock.METHODS A total of 101 patients with severe septic shock who were treated in Wuhan No.1 Hospital from Jan 2017 to Jan 2021 were assigned as the study group and were divided into the death group with 33 cases and the survival group with 68 cases according to the treatment outcomes within 28 days after the admission to intensive care unit(ICU),meanwhile,120 healthy people who received physical examination were chosen as the control group.The secretions from infection sites and blood specimens were collected from the patients with severe septic shock,the isolated pathogens were identified.The expression levels of TLRs signaling pathway-related factors TLR2 mRNA,TLR4 mRNA and nuclear factor-kB(NF-kB)in PBMCs and the levels of peripheral blood T lym-phocyte subsets and inflammatory factors were observed and compared between the study group and the control group,and between the death group and the survival group.RESULTS Totally l17 strains of pathogens were isolated from thel01 patients with severe septic shock,68.38%of which were gram-negative bacteria.The expression levels of TLR2 mRNA,TLR4 mRNA and NF-κB in PBMCs and the levels of peripheral blood CD_(4)^(+),interleukin-4(IL-4)and tumor necrosis factor-α(TNF-α)were significantly higher in the study group than in the control group(P<0.05),while the levels of CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+),IL-10 and interferon-γ(IFN-γ)of the study group were significantly lower than those of the control group(P<0.05).The expression levels of TLR2 mRNA,TLR4 mRNA and NF-κB in PBMCs and the levels of peripheral blood CD_(8)^(+),IL-4 and TNF-αwere significantly higher in the death group than in the survival group(P<0.05);the levels of CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+),IL-10 and IFN-γ of the death group were significantly lower than those of the su

关 键 词：重症 感染性休克 TOLL样受体 外周血单个核细胞:T淋巴细胞亚群 炎症因子 

分 类 号：R631.4[医药卫生—外科学]