TLR2和TLR4在单肺通气麻醉中的表达

摘要

Objective:To investigate the expression of TLR2 and TLR4 in one-lung ventilation anesthesia and evaluate their clinical value.Methods:Thirty patients scheduled for lobectomy were allocated randomly to two groups:Group A,two-lung ventilation (n =11),Group B,one-lung ventilation (n =19).The contents of IL-8 and TNF-α in serum of both groups which collectived 15 min (T1),30 min (T2),45 min (T3),90 min (T4) after thoracotomy/one-lung ventilation respectively were detected by enzyme-linked immunosorbent assay.Transmission electron microscopy was employed to observe the cell pathological changes of lung tissue.Semi-quantitative reverse transcriptase-polymerase chain reaction was adopted to detect the expression of TLR2 and TLR4 mRNA and immunohistochemical (IHC) staining for TLR2 and TLR4 to test their expression in the lung tissue.Results:Transmission electron microscopy showed that inflammatory alterations were observed in groups A and B,and the inflammation in group B was more serious than that in group A.Compared with the group A obvious aleolar epithelial type Ⅱ cells swelling,number of microvilli and lamellar body decreased,part of cavitation model changes,mitochondrial mild swelling and disordered arrangement of part of the ridge of the mitochondrial mild were observed in the group B.Expression of TLR2 and TLR4 mRNA in the lung tissue of the group B was significantly increased than that of the group A (P＜0.05).The contents of IL-8 and TNF-α in serum of both groups were slightly increased at different time points (P ＞0.05),but compared with the 15 min (T1) group it was markedly increased in the 90 min (T4) group (P＜0.05).Compared with the group A the positive rate of IHC staining for TLR2 and TLR4 in the lung tissue was markedly increased in the group B (P＜0.05).Conclusion:In the condition of one-lung ventilation,the up-regulated of TLR2 and TLR4 may play a role in the lung inflammation.%目的:研究Toll样受体2(TLR2)和Toll样受体4(TLR4)在单肺通气麻醉过程中的表达变化并探讨其临床意义.方法:选择胸科肺癌行肺叶切除手术30例,随机分为两组,A组(n=11,双肺通气),B组(n=19,单肺通气组),收集开胸后/单肺通气后15(T1),30(T2),45(T3),90(T4)min血清,采用ELISA法检测两组血清中IL-8,TNF-α的表达；收集切除标本后的肺组织,电子显微镜观察细胞形态病理变化,采用RT-PCR检测TLR2 mRNA和TLR4 mRNA,免疫组化检测肺组织TLR2和TLR4蛋白的表达.结果:电镜检测表明:两组均发生肺细胞炎症反应,其中B组发生炎性反应明显比A组显著；两组TLR2 mRNA和TLR4 mRNA表达比较,B组的TLR2 mRNA和TIR4 mRNA表达明显高于A组,差异有统计学意义(P＜0.05);A、B两组中的IL-8,TNF-α浓度在各时点均有不同程度的升高,其中组内比较T4时点的IL-8,TNF-α浓度明显高于T1时点,差异有统计学意义(P＜0.05)；A、B两组间比较,在T4时点IL-8,TNF-α浓度B组明显高于A组,差异有统计学意义(P＜0.05),其余时点表达比较差异无统计学意义(P＞0.05).A、B两组免疫组化比较,B组的TLR2和TLR4阳性率明显高于A组,差异有统计学意义(P＜0.05).结论:单肺通气期间,随着时间的延长,炎症反应更为显著,TLR2、TLR4表达上调并参与炎症反应.