重症肺炎血清和肺泡灌洗液Toll样受体4水平及外周血免疫细胞计数变化  

Changes of Toll-like receptor 4 in serum and bronchoalveolar lavage fluid and immune cells in peripheral blood of severe pneumonia patients

作　　者：雷晓霞[1] 袁文胜[1] LEI Xiao-xia;YUAN Wen-sheng(Wuhan First Hospital,Wuhan,Hubei 430000,China)

机构地区：[1]武汉市第一医院呼吸与危重症医学科,湖北武汉430000

出　　处：《中华医院感染学杂志》2024年第21期3201-3205,共5页Chinese Journal of Nosocomiology

基　　金：湖北省卫生计生委科研基金资助项目(WJ2015MB238)。

摘　　要：目的探讨重症肺炎(SP)血清和肺泡灌洗液Toll样受体4(TLR4)水平及外周血免疫细胞计数变化。方法选取武汉市第一医院2021年10月-2023年10月187例肺炎患者为研究对象,其中92例SP患者为重症组,95例非SP患者为非重症组。用酶联免疫吸附法检测血清和肺泡灌洗液TLR4水平,流式细胞仪检测外周血免疫细胞计数,根据住院28 d生存情况将SP患者分为存活组69例、死亡组23例,分析SP患者28 d内病死的危险因素及实验室指标对患者预后的预测价值。结果重症组入院时肺炎严重指数(PSI)、急性生理与慢性健康(APACHE)Ⅱ评分、血清及肺泡灌洗液中的TLR4水平均高于非重症组(P<0.05),外周血淋巴细胞及单核细胞计数均低于非重症组(P<0.05);SP患者死亡组PSI评分、APACHEⅡ评分、血清及肺泡灌洗液中的TLR4水平均高于存活组,外周血淋巴细胞及单核细胞计数均低于存活组(P<0.05);高水平血清及肺泡灌洗液TLR4是SP患者28 d内病死的危险因素(P<0.05);血清及肺泡灌洗液TLR4、外周血淋巴细胞及单核细胞计数预测患者28 d内病死的曲线下面积分别为0.750、0.764、0.715和0.689。结论高水平TLR4以及低水平的免疫细胞计数可能增加SP患者病死风险,检测上述指标可帮助临床评估患者预后。OBJECTIVE To explore the changes of serum and bronchoalveolar lavage fluid(BALF)Toll-like receptor 4(TLR4)and peripheral blood immune cells of the patients with severe pneumonia(SP).METHODS A total of 187 patients with pneumonia who were treated in Wuhan First Hospital from Oct.2021 to Oct.2023 were recruited as the research subjects,92 of whom had SP and were assigned as the severe group,and 95 did not have SP and were assigned as the non-severe group.The levels of serum and BALF TLR4 were detected by means of enzyme-linked immunosorbent assay,the counts of peripheral blood immunocytes were detected by flow cytometry.The SP patients wee divided into the survival group with 69 cases and the death group with 23 cases according to the 28-day survival status during the hospital stay.The risk factors for the death of the SP patients within 28 days were observed,and the values of laboratory test indexes in prediction of prognosis were analyzed.RESULTS The pneumonia severity index(PSI),acute physiology and chronic health evaluation(APACHE)Ⅱscore and serum and BALF TLR4 level of the severe group were significantly higher than those of the non-severe group at the admission to hospital(P<0.05),while the counts of peripheral blood lymphocytes and monocytes of the severe group were significantly lower than those of the non-severe group(P<0.05).The PSI score,APACHEⅡscore and serum and BALF TLR4 level of the death group were significantly higher than those of the survival group,and the counts of peripheral blood lymphocytes and monocytes of the death group were significantly lower than those of the survival group(P<0.05).The high levels of serum and BALF TLR4 were the risk factors for the death of the SP patients(P<0.05).The areas under the curves(AUCs)of the serum TLR4,BALF TLR4,peripheral blood lymphocytes and peripheral blood monocytes were respectively 0.750,0.764,0.715 and 0.689 in prediction of 28-day death of the patients.CONCLUSION The high levels of TLR4 and low levels of immune cells may increase the risk of dea

关 键 词：重症肺炎 肺泡灌洗液 TOLL样受体4 免疫细胞 危险因素 预后 28 d病死 

分 类 号：R563[医药卫生—呼吸系统]