心脏体外循环手术TLR4的表达与术后呼吸机相关性肺炎关系的临床研究

The clinical research of the relationship between expression of TLR4 in patients undergoing cardiac surgery with cardiopulmonary bypass and ventilator-associated pneumonia

目的:探讨心脏体外循环手术中Toll样受体4(TLR4)的表达变化与术后呼吸机相关性肺炎(VAP)发生发展的联系。方法:选取20例体外循环下心内直视手术的患者,根据术后是否发生呼吸机相关性肺炎分为两组:A组(VAP组),B组(对照组)。分别于体外循环开始即刻(T1),体外循环后20 min(T2),体外循环后40 min(T3),体外循环结束即刻(T4)采集所有患者左心房血液,利用流式细胞术法观察粒细胞TLR4的表达变化。同时分析患者术前一般状况,术中体外循环手术情况,术后呼吸机相关性肺炎的发生发展状况。结果:有8例患者术后发生呼吸机相关性肺炎,其体外循环时间和术中T3、T4时间点左房血粒细胞TLR4的表达均显著高于未发生呼吸机相关性肺炎患者。结论:长时间体外循环通过激活TLR4促进术后呼吸机相关性肺炎的发生发展。

Objective：To test the hypothesis that ventilator-associated pneumonia（VAP） after cardiac surgery with cardiopulmonary bypass （CPB） requires TLR4-dependent signaling. Methods：Twenty patients were categorized into two groups based on development of VAP following CPB,group with VAP （group A） and group VAP without （group B）. The blood samples of left atrium were collected in both groups at the time points of preoperation （T1）,20 rain （T2）,40 rain （T3） and end （T4） of CPB. Expression of TLR4 on granular leukocyte was detected with flow cytometry. The cinical data of all cases in two groups were compared. Results：VAP occurred in 8 patients. CPB time in group A was statistically longer than in group B. The expression of TLR4 on granular leukocyte in group A at the time points of T3 and T4 were significantly higher than those in group B. Conclusion：Development of VAP after cardiac surgery with CPB was promoted by long CPB time via TLR4-dependent signaling activated.