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目的分析重症肺炎患者外周血单核细胞Toll样受体4(TLR4)的表达变化,为临床观察重症肺炎的预后与治疗效果提供依据。方法选取2010年1月至2014年12月于重庆市开县安康医院诊治的重症肺炎患者120例为观察组,同时选取本院健康体检者120例为对照组;应用逆转录PCR技术和流式细胞术检验两组患者在治疗第1、3、7天时的外周血单核细胞TLR4表达;根据观察组患者的存活情况分为生存组与死亡组,并进行急性生理与慢性健康评分和社区获得性肺炎CURB-65评分,常规检测C反应蛋白和降钙素原水平。结果观察组在外周血单核细胞TLR4 m RNA及TLR4 rMFI方面显著高于对照组,差异有统计学意义(P<0.05)。观察组在治疗第3、7天时的TLR4 mRNA及TLR4 rMFI方面比第1 d时出现明显的下降(P<0.05)。在一个月后的随访调查中,观察组死亡率为31.7%(38/120),死亡组在急性生理与慢性健康评分、社区获得性肺炎CURB-65评分以及降钙素原水平等方面都显著高于生存组,但生存组在外周血单核细胞TLR4蛋白表达方面高于死亡组(P<0.05)。结论重症肺炎患者外周血单核细胞TLR4表达水平与正常人相比较高。
Objective To analyze the expression of Toll-like receptor 4 (TLR4) in peripheral blood mononuclear cells of patients with severe pneumonia and provide the basis for clinical observation of the prognosis and treatment effect of severe pneumonia. Methods One hundred and twenty cases of severe pneumonia diagnosed and treated in Ankang Hospital of Kaixian City in Chongqing from January 2010 to December 2014 were selected as observation group and 120 healthy subjects in our hospital were selected as control group. Reverse transcription PCR and flow cytometry The levels of TLR4 expression in peripheral blood mononuclear cells of the two groups were tested at the 1st, 3rd, 7th day after operation. According to the survival of patients in the observation group, survival and death groups were divided into two groups: acute physiology and chronic health score and community acquired Pneumonia CURB-65 score, Routine detection of C-reactive protein and procalcitonin levels. Results The levels of TLR4 mRNA and TLR4 rMFI in peripheral blood mononuclear cells of observation group were significantly higher than those of control group (P <0.05). There was a significant decrease in TLR4 mRNA and TLR4 rMFI in the observation group on the 3rd and 7th day after treatment (P <0.05). In a follow-up survey one month later, the mortality in the observation group was 31.7% (38/120). The death group was significantly associated with acute physiology and chronic health scores, CURB-65 scores of community-acquired pneumonia, and procalcitonin levels But survival group was higher than death group in the expression of TLR4 protein in peripheral blood mononuclear cells (P <0.05). Conclusion The expression of TLR4 in peripheral blood mononuclear cells in patients with severe pneumonia is higher than that in normal subjects.