连续性血液净化对严重脓毒症患者Toll样受体及炎症介质的影响

Effect of continuous blood purification on toll-like receptor and inflammatory mediator in patients with severe sepsis

目的探讨连续性血液净化（cBP）对严重脓毒症患者Toll样受体及炎症介质的影响。方法30例严重脓毒症患者随机分成常规治疗组和CBP治疗组，每组15例；另选15名健康志愿者为对照组。在治疗的不同时间点，检测单核细胞Toll样受体一2（TLR2）7NTLR4的蛋白表达及血清TNF-α、IL-6、IL-10的浓度。结果严重脓毒症患者TLR2／4的蛋白表达及TNF—α、IL-6、1L-10的浓度水平，均明显高于健康对照组（均P〈0．05）。CBP可下调TLR2／4的蛋白表达及TNF—α、IL-6的浓度水平（R0．05）。结论CBP通过下调TLR2／4的蛋白表达，抑制过于亢进的非特异性免疫反应；通过降低血清炎症介质的浓度，使促炎和抗炎反应达到相对平衡。

Objective To explore the effect of continuous blood purification （CBP） on toll-like receptor and inflammatory mediator in patients with severe sepsis. Methods A total of thirty patients with severe sepsis were enrolled randomly in two groups： fifteen in common therapy group and the other fifteen in CBP therapy group. Another fifteen healthy volunteers served as control. At different time points of therapy, the protein expression of toll-like receptor-2 （TLR2）, TLR4 on monocyte was investigated by flowcytometry and the serum concentrations of tumor necrosis factor-α （TNF-α）, interleukin-6 （IL-6）, IL-10 were measured by enzyme linked immunosorbent assay （ELISA）. Results Patients with severe sepsis were characterized by an increased protein expression of TLR2, TLR4 on monocyte and an elevated serum concentration of TNF-c~, IL-6 and IL-10 compared to controls （P〈0.05）. CBP down-regulated the protein expression of TLR2 and TLR4 on monocyte and lowered the serum concentrations of TNF-α and IL-6 （P〈0.05）. Conclusion CBP can suppress the excessive hyperfunction of nonspecific immune system in the patients with severe sepsis by down-regulation of the protein expression of TLR2 and TLR4 on monocyte, and can relatively balance proinflammatory response and anti-inflammatory response by lowering the serum concentrations of inflammatory mediator.