辛伐他汀对脓毒症患者外周血单核细胞Toll样受体4及基质金属蛋白酶9的影响分析

Effect of simvastatin on Toll like receptor 4 and matrix metalloproteinase 9 in peripheral blood mononuclear cells of patients with sepsis

目的分析辛伐他汀对脓毒症患者外周血单核细胞(PBMCs)Toll样受体4(TLR4)及基质金属蛋白酶9(MMP-9)的影响,探讨其临床应用价值。方法选取本院2014年10月至2015年10月收治的180例脓毒症患者,随机分为观察组、对照组,各90例,均实施脓毒症常规综合治疗,观察组加用辛伐他汀口服,1次/d,每次40 mg,持续15 d。比较两组患者治疗前后PBMCs TLR4、MMP-9表达情况、血清炎性因子水平变化及病死率。结果两组患者治疗后TLR4均显著降低,观察组降低更为明显;治疗1 d后,两组患者MMP-9均有所上升,而后逐渐下降,观察组下降更为明显,差异有统计学意义(P<0.05)。两组患者治疗后TNF-α、IL-1β、IL-6均显著下降,IL-10均显著上升,观察组变化更为明显,差异有统计学意义(P<0.05)。观察组治疗4周后病死率为20.00%,略低于对照组的26.67%,但差异无统计学意义(P>0.05)。结论辛伐他汀能够显著降低脓毒症患者PBMCs TLR4、MMP-9表达,延缓患者炎症反应进程,值得进一步推广研究。

Objective To analyze the effect of simvastatin on patients with sepsis in peripheral blood mononuclear cells（ PBMCs） toll like receptor 4（ TLR4） and matrix metalloproteinase 9（ MMP-9）,and to explore the influence of its value in clinical application. Methods The 180 cases of sepsis patients in our hospital from October 2014 to October 2015 were selected,and randomly divided into observation group and the control group,90 cases in each group,the general sepsis treatment was conducted,observation group plus with simvastatin orally,once a day,40 mg each time,continuously 15 days. Compared the two groups of patients before and after the treatment of TLR4 MMP-9,PBMCs expression,serum inflammatory factor levels and mortality rate. Results After treatment,the patients in the two groups of TLR4 were decreased significantly,and the observation group decreased more significantly; after treatment for 1 day,two groups of patients with MMP- 9 increased,then decreased gradually,decline in the observation group was more obvious,the difference was statistically significant（ P〈0.05）,TNF- alpha,IL-1 beta,IL-6 were significantly decreased after treatment in two groups,IL-10 were significantly increased,the observation group was more obvious（ P〈0.05）. The mortality rate of the observation group after 4 weeks＇ treatment was 20%,slightly lower than that of the control group（ 26.67%）（ P〉 0.05）. Conclusion Simvastatin can significantly reduce the expression of TLR4MMP-9 and PBMCs in patients with sepsis,and delay the progression of inflammatory reaction,which is worthy of further study.