严重脓毒症患儿Toll样受体4水平及临床意义

The level and clinical significance of Toll-like receptor 4 in children with severe sepsis

目的探讨Toll样受体4（TLR4）水平在严重脓毒症患儿中的临床意义。方法采用前瞻性病例对照研究方法，选择儿科重症监护病房（ICU）住院且诊断符合严重脓毒症、脓毒性休克患儿14例（严重脓毒症组），以同期住院的支气管肺炎患儿（肺炎组）及健康体检儿童（健康对照组）各10例作为对照。取患儿入院时静脉血2ml，用流式细胞仪检测TLR4水平，用酶联免疫吸附法（EuSA）测定血清白细胞介素（IL-6、IL-10）、肿瘤坏死因子-α（TNF—α）含量。结果严重脓毒症组TLR4[（71．56±15．32）％]、IL-6[（1．98±1．55）ng／L]、IL-10[（88．20±61．23）ng／L]、TNF—α[（104．08±85．36）ng／L]水平均显著高于肺炎组[分别为（50．07±26．36）％、（0．93±0．16）ng／L、（41．42±7．02）ng／L、（48．96±6．40）ng／L]与健康对照组[分别为（39．43±17．43）％、（0．94±0．43）ng／L、（43．73±22．68）ng／L、（49．94±18．47）ng／L]，差异均有统计学意义（均P〈0．05）；而肺炎组与健康对照组间比较差异均无统计学意义（均P〉0．05）。结论TLR4是脓毒症发生与发展的启动点，其水平与促炎因子IL-6、TNF—α及抗炎因子IL-10水平一致；若将TLR4的变化与部分炎症介质水平相互结合，可作为脓毒症患儿早期诊断和病情严重程度的预测指标。

Objective To study the clinical significance of Toll-like receptor 4 （TLR4） in children with severe sepsis. Methods A prospective control study was performed. All cases were enrolled from pediatric department of the First Affiliated Hospital of Guangzhou Medical College, and they were divided into severe sepsis group （14 patients） who were diagnosed to have severe sepsis or septic shock in intensive care unit （ICU）, pneumonia group （10 cases） with diagnosis of bronchial pneumonia, and healthy control group （10 healthy children）. Venous blood samples of 2 ml were collected at admission, the level of TLR4 was detected by flow eytometry . At the same time, the changes in serum interleukin （IL-6, IL-10 ） and tumor necrosis faetor-a （TNF-a） levels were determined by enzyme linked immunoadsorbent assay （ELISA）. Results In severe sepsis group, the contents of TLR4 （（71.56± 15.32）%], IL-6 （（1.98±1.55） ng/L], IL-10 （（88.20± 61.23） ng/L] and TNF-α C（104.08± 85.36） ng/L] were significantly higher than those in pneumonia group （（50. 07 ± 26.36） %, （0.93 ± 0.16） ng/L, （41.42 ±7.02） ng/L, （48.96 ± 6.40） ng/L] and healthy control group [（39.43 ± 17.43）%, （0.94± 0. 43） ng/L, （43.73± 22.68） ng/L, （49.94± 18. 47） ng/L, all P〈0. 05）. But there was no significant difference in the contents of TLR4, IL-6, IL-10 and TNF-α between pneumonia group and healthy control group （all P〉0.05）. Conclusion This study suggests that TLR4 might be critically involved in the development of sepsis, and changes in TLR4 expression are parallel with levels of proinflammatory cytokines, including IL-6, TNF-α, and IL-10. The combination of TLR4 and proinflammatory cytokines would serve as the predictive parameters in early diagnosis and severity evaluation of sepsis in children.