肝移植术病人围术期中性粒细胞Toll样受体2表达与术后SIRS的关系

Relationship between Toll-like receptor 2 on polymorphonuclear neutrophil and postoperative systemic inflammatory response syndrome in patients undergoing orthotopic liver transplantation

目的 研究肝移植术病人围术期中性粒细胞Toll样受体2（TLR2）表达与术后全身炎性反应综合征（SIRS）的关系。方法 择期行肝移植术的终末期肝病病人20例，年龄33～58岁，体重52～73kg，心功能Ⅱ或Ⅲ级，ASAⅢ或Ⅳ级。于麻醉诱导前（T1）、无肝期25min（T1）、新肝期3h（L3）、新肝期24h（T4）时，中心静脉采血样，采用流式细胞仪测定中性粒细胞TLR2表达；ELISA法测定血清肿瘤坏死因子．α（TNF-α）、白细胞介素-1β（IL-1β）和白细胞介素-8（IL-8）浓度；按术后7d内是否发生SIRS，分为SIRS组与非SIRS组。2组TNF-α、IL-1β和IL-8浓度和TLR2表达进行Spearman相关分析。结果术后7d内有10例病人发生SIRS。与T1时比较，SIRS组T4时中性粒细胞TLR2表达上调，T2-4时TNF-α浓度升高，L3.4时IL-1β浓度升高，L3时IL、8浓度升高（P〈0．05或0．01）；与NSIRS组比较，SIRS组L时中性粒细胞表达上调，血清IL-1β浓度升高，L3时血清IL-8浓度升高（P〈0．05或0．01）。SIRS组TNF-α浓度与中性粒细胞TLR2表达呈正相关（r=0．607，P〈0．05）。结论 肝移植术后病人发生SIRS可能与新肝期24h中件粒绷胸TLR2表达上调有关。

Objective To investigate the role of Toll-like receptor 2 （TLR2） on polymorphonuclear neutrophil （PMN） during pefioperative period in the development of postoperative systemic inflammatory response syndrome （SIRS） in patients undergoing orthotopic liver transplantation （OLT） .Methods Twenty ASA Ⅲ or IV patients （NYHA Ⅱ or Ⅲ ） of both sexes （18 male, 2 female） aged 33-58 yr weighing 52-73 kg undergoing OLT were studied. Blood samples were collected from central vein for determination of TLR2 expression on PMN and plasma TNF-α, IL-1β and IL-8 concentrations before induction of anesthesia （T1 , baseline）, at 25 min of anhepatic phase （T2）, 3 h （T3） and 24 h after beginning of reperfusion of the allograft （T4 ）. The expression of TLR2 was measured by flow cytometry and the serum concentrations of TNF-α, IL-1β and IL-8 were measured by enzyme linked immuno-sorbant assay （ELISA）. The patients were divided into SIRS and non-SIRS group depending on whether the patients developed SIRS or not within 7 days after operation. The diagnosis of SIRS was based on the criteria laid down by ACCP and SCCM in 1992. Results Ten patients developed SIRS within 7 days after operation. There was no significant difference in Child-Turcotte-Pugh （CTP） scores between the 2 groups. Compared with non-SIRS group, the TLR2 expression on PMN and the serum IL-1β concentration were significantly increased at T4 , and the serum IL-8 concentration were significantly increased at T3 in SIRS group. There was positive correlation between serum TNF-α concentration and TLR2 expression on PMN in SIRS group （ r = 0.607, P 〈 0.05）. Conclusion The expression of TLR2 on PMN increases significantly at 24 h after beginning of reperfusion of allograft and may play an important role in the development of postoperative SIRS.