重症急性胰腺炎患者血浆TNF-α、IL-6浓度与外周血单核细胞TLR4表达的变化及临床意义

Changes of Plasma Levels of TNF-α and IL-6 and the Expression of TLR4 in Peripheral Blood MononuclearCell in Patients with Severe Acute Pancreatitis and Their Clinical Significance

【目的】探讨重症急性胰腺炎（SAP）早期机体免疫功能指标的变化及其临床意义。【方法】选择2007～2009年本院急诊及住院临床诊断明确的SAP患者32例（SAP组），轻症胰腺炎（MAP）48例（MAP组），同时以健康自愿者35例作为对照（NC组）。采用ELISA法测定受试者血浆肿瘤坏死因子一α（TNF-α）和白介素一6（IL-6）浓度，流式细胞法检测外周血单核细胞上TLR4的表达。患者检测时间均为发病后12h内。【结果】SAP组TLR4阳性表达百分比为（67．23±10．71）％，MAP组及NC组分别为（48．38±8．55）％和（30．75士5．25）％；TLR4荧光强度（MFI），分别为（78．30±8．96）％、（42．98士5．12）％、（27．20±5．75）％；血浆TNF_a分别为（38．79±6．65）pg／mL、（29．15士5．62）pg／mL和（21．38±5．60）pg／mL，IL一6浓度分别为（19．85±4．78）pg／mL、（14．55±3．91）pg／mL、（10．25士4．59）pg／mL，SAP组与MAP组及NC组比较差异均有显著性（均P〈0．01）。SAP组TLR4表达荧光强度与血浆中TNF-α、IL一6浓度呈明显正相关（r=0．997和0．995，P〈0．05）。【结论】sAP患者外周血单核细胞TLR4的阳性高表达与血浆TNF-α及IL一6明显增高呈正相关，提示MAP早期发病与先天性免疫系统的激活及炎症介质的释放密切相关，检测上述指标对重症胰腺炎的判定具有潜在临床价值。

[Objective] To determine the plasma levels .of tumor necrosis factor-alpha（TNF- α） and interleukin- 6 （IL- 6 ） and the expression of Toll-like receptor 4（TLR4） in peripheral blood mononuclear cell in patients with early severe acute pancreatitis（SAP）, and to analyze their correlation, and to explore the change of the indicators of early immune function in SAP and their clinical significance. [Methods] Thirty two patients diagnosed as SAP（SAP group） in emergency room and ward in our hospital from 2006 to 2008 were chosen. Of all the patients, 23 cases were male and 9 cases were female, and their mean age was （40-3） years old, and the mean disease duration was （0.8-0.27） days. Forty eight cases of mild SAP（MAP group） included 35 males and 13 females with the mean disease duration of （0.8-0.16） days. Thirty five healthy people were taken as the control group; Within 12h after the onset of SAP, ELISA was used to measure the plasma levels of TNF-α and IL-6 of the subjects, and flow cytometry was used to detect the expression of TLR4 in peripheral blood mononuclear cells. [Results] The positive expression rate of TLR4 in peripheral blood mononuclear cell in SAP group, MAP group and control group was（67.23 ±10.71） %, （48.38± 8. 55）%and （30.75 ± 5.25） %, respectively. The fluorescence intensity（MFI） of TLR4 in SAP group, MAP group and control group were （78. 30 4± 8.96） %, （42.98 ± 5.12） % and （27.20 4±5.75） %, respectively. The plasma level of TNF-α in SAP group, MAP group and control group was （38.79 4± 6.65） pg/ mL, （29. 15 4± 5.62） pg/ml and （21.38±5.60）pg/mL, respectively. The plasma level of IL-6 in SAP group, MAP group and con- trol group was （19.85 4±4.78） pg/mL, （14.55±3.91） pg/mL and （10.25 4±4. 59） pg/mL, respectively. There were significant differences between SAP group and MAP group or control group（all P d0.01 ）. The MFI of the expression of TLR4 in peripheral blood mononuclear cell in SAP group had significantly positive relation with the plasma levels of TNF-a and IL-6（r=0. 997 and 0. 995, P = 0. 045 and 0. 048, P d0. 05）. [Conclusion] The high positive expression of TLR4 in peripheral blood mononuclear cell in SAP patients has positive relation with the increased plasma levels of TNF-α and IL-6, which suggests that early onset of MAP is closely related with innate immune system activation and release of inflammatory mediators. The detection of above indexes has potential clinical value in the identification of MAP.