Toll样受体在新生儿败血症患者中的动态变化及临床意义

Dynamic changes and clinical significance of Toll-like receptor expression in neonatal sepsis

目的：观察Toll样受体（TLR2、TLR4）在新生儿败血症病程中的动态变化，探讨其在新生儿抗感染免疫中的作用。方法将60例不同胎龄（31～42周）新生儿分为败血症组和对照组。应用流式细胞仪检测败血症组感染后第1天、第7～10天和非感染组第1天的外周血单核细胞和粒细胞表面TLR2、TLR4蛋白表达；同时检测血CRP、WBC、血小板。结果感染后第1天，败血症组TLR2蛋白在粒细胞和单核细胞的表达水平及CRP均高于非感染组（ P均＜0．05）；第7～10天，TLR2在粒细胞的表达水平接近对照组，而在单核细胞中则持续高表达（ P＜0．05）。败血症组TLR4在粒细胞表面持续低表达，在单核细胞表达高于粒细胞（ P＜0．05）；第7～10天，TLR4在单核细胞表达水平明显下降，接近对照组，但与第1天比P＜0．05。两组治疗前后WBC、血小板均变化不明显。结论新生儿败血症患儿外周血单核细胞和中性粒细胞表面TLR2、TLR4蛋白表达异常增高，提示TLR信号传导途径参与了新生儿的抗感染免疫机制，与新生儿败血症的发生、发展密切相关。

Objective To investigate the dynamic changes of Toll-like receptors （ TLR2 and TLR4 ） in neonatal sepsis, and to determine their roles in neonatal bacterial infection.Methods A total of 60 neonates aged 31-42 weeks were divided into two groups： sepsis group （ n=30 ） and control group （ n=30 ） .The protein expression of TLR 2 and TLR 4 in monocytes and granulocytes in peripheral blood were evaluated by flow cytometry on day 1 after infection and day 7-10 （ after sepsis cured） in the sepsis group and on day 1 in the control group, respectively;mean-while, the CRP, WBC and blood platelets were detected.Results On day 1, TLR2 expression in granulocytes and monocytes and CRP expression in the sepsis group were higher than those of the control group （ all P＆lt;0 .05 ） .On day 7-10 , TLR2 expression in the granulocytes of the sepsis group rapidly decreased to control values in comparison to the control group, while in monocytes, the expression of TLR2 remained high expression （ P ＆lt;0.05 ） .In the sepsis group, the expression of TLR4 in granulocytes remained low expression and showed no significant changes, but the ex-pression level of TLR4 in the monocytes was higher as compared with that in the granulocytes （ P＆lt;0 .05 ） .On day 7-10, the expression level of TLR4 in the monocytes decreased to control values in the sepsis group, and significant differences were found between the levels of day 1 and day 7-10 （ P＆lt;0.05） .WBC, platelets in the two groups had no significant changes before and after treatment.Conclusions The protein expression levels of TLR 2 and TLR 4 in-crease significantly in the neonatal sepsis groups, and have a dynamic changes in the course of sepsis, suggesting that TLR signal pathway takes part in the immune mechanism of neonatal anti-infection and is closely related to onset and progress of neonatal sepsis.