扩张型心肌病Toll样受体4表达及与肿瘤坏死因子-α相关性研究

Correlation between TNF-αconcentration and TLR4 expression in children with dilated cardiomyopathy.

目的观察扩张型心肌病(DCM)患儿外周血单核细胞Toll样受体4(Toll-like receptor4,TLR4)表达及与肿瘤坏死因子-α(TNF-α)浓度的相关性,探讨其与小儿DCM发生发展的关系。方法 2008年4月至2008年12月重庆医科大学附属儿童医院收治的DCM患儿18例,治疗前和治疗1年后分别应用流式细胞术检测外周血单核细胞TLR4的表达水平,ELISA法检测其血清TNF-α含量,心脏彩超检测其左室射血分数(LVEF)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室质量(LVmass),对照组为健康儿童17名。结果 DCM患儿治疗前外周血单核细胞TLR4平均荧光强度(MFI)及血清TNF-α浓度高于治疗1年后(P<0.05),且DCM患儿治疗前后均高于对照组(P<0.05)。TLR4表达与血清TNF-α水平呈正相关(P<0.05),且DCM患儿治疗前后TLR4、TNF-α水平的降低程度与LVEF、LVEDV、LVESV、LVmass改善程度相关。结论小儿DCM的TLR4上调,可能通过促使炎性因子分泌增多而损害心肌,介导小儿DCM的发生发展。

Objective To observe the correlation between the expression of Toll-like receptor 4 （TLR4）in monocytes and the concentration of TNF- α in children with dilated cardiomyopathy （DCM）, in order to explore the relationship between TLR4 and the occurrence and development of children with DCM. Methods In 18 children with DCM, TLR4 level in monocytes was measured by flow cytometry; the concentration of TNF-α in serum was determined by ELISA; left ventricular ejection fraction（LVEF） ,left ventricular end-diastolic volume（LVEDV）, left ventricular end-systolic volume （LVESV） and left ventricular mass （LVmass） were detected by echocardiography. Seventeen healthy children served as controls. Results The mean fluorescence intensity（ MFI ）of TLR4 in monocytes was higher in children with DCM at preliminary diagnosis, compared to that of treatment of one year. TNF- α had a similar resuh（P 〈 0.05）.Moreover,they were both higher in chidren with DCM compared with controls. The improvement of LVEF, LVEDV, LVESV and LV mass in children with DCM correlated with the decrease of TLR4MFI and with the concentration of TNF- α. Conclusion Upregulation of TLR4 in monocytes of children with DCM may play a critical role in the mechanism of cardiac damage through the secretion of inflammatory factors,which mediates the development and progression of children with DCM.