间歇性高容量血液滤过对严重脓毒症外周血单核细胞Toll样受体表达的影响

摘要

Objective To explore the effect of pulse high - volume hemofiltration ( PHVHF) on the expression of toll - like receptor -2(TLR2) and TLR4 messenger RNA on periheral blood monocytes in patients with severe sepsis. Methods Forty patients with severe sepsis were included in the study. Patients were randomly divided into the conventional treatment group and the PHVHF group. Each group had twenty patients. Another fifteen healthy volunteers served as control. On admission(before treatment) , on 24,48 and 72h after therapy, the TLR2 and TLR4 messenger RNA expression on monocytes was detected by RT - PCR and the plasma concentrations of tumor necrosis factor a ( TNF -a) , interleukin -6(IL-6) were measured by enzyme linked immunosorbent assay ( ELISA). The acute physiology and chronic health evaluation II (APACHE II ) score and sequential organ failure assessment SOFA) were observed at the same time. Results We found an increased expression of TLR2 and TLR4 on monocytes and an elevated plasma concentrations of TNF - a and IL -6 in patients with severe sepsis compared with healthy controls (P<0.01). PHVHF suppressed significantly the expression of TLR2 and TLR4 mRNA on monocytes and lowered the plasma concentrations of TNF - a and IL - 6, which had significant difference as compared those in conventional treatment group (P<0. 01 ). However, the above indexes was not significantly different in conventionai treatment group after therapy. Conclusion PHVHF displayed an down - regulation of the excessive inflammatory response and improve clinical features. Inhibition of TLR2 andTLR4 may be a novel treatment machanism of PHVHF in severe sepsis.%目的 探讨间歇性高容量血液滤过(PHVHF)对严重脓毒症患者外周血单核细胞Toll样受体2(TLR2)和4(TLR4) mRNA表达的影响.方法 40例严重脓毒症患者随机分成常规治疗组和PHVHF组,每组20例,另选15名健康志愿者为对照组.在治疗前、治疗24、48、72h,用RT-PCR法检测单核细胞TLR2和TLR4 mRNA表达,酶联免疫吸附法(ELISA)检测血浆中肿瘤坏死因子-α(TNF-α)和白介素-6(IL-6)浓度.同时进行急性生理和慢性健康状况评分(APACHE)Ⅱ和序贯器官功能衰竭评分(SOFA).结果 严重脓毒症患者TLR2和TLR4 mRNA表达及TNF-α、IL-6的浓度水平,均明显高于健康对照组(P＜O.01).72h治疗后,PHVHF可明显下调TLR2和TLR4 mRNA的表达及TNF-α、IL-6的浓度水平,且与同期常规治疗组比较显著降低,差异均有统计学意义(P＜0.01);而常规治疗组治疗前后比较无统计学差异(P＞0.05).结论 PHVHF可下调严重脓毒症过度的炎症反应,改善临床病情,抑制单核细胞表面TLR2、TLR4表达可能是其治疗严重脓毒症的机制之一.