Toll样受体3在脓毒症并心功能障碍患儿中的表达及意义

Expression and clinical signifcance of Toll-like receptor 3 in children with septic cardiac dysfunction

目的 探讨脓毒症并心功能障碍患儿外周血Toll样受体3（TLR3）的表达及其临床意义.方法 采用前瞻性对照研究方法,选取2015年10月至2017年3月在汕头市中心医院儿科住院且诊断符合脓毒血症不伴心功能障碍的患儿20例（脓毒血症组）、脓毒血症并心功能障碍患儿24例（脓毒性心功能障碍组）、非脓毒性心功能障碍的患儿10例（非脓毒性心功能障碍组）和健康体检儿童30例（对照组）作为研究对象,各组儿童均在入院24 h内留取新鲜外周血2 ml,用流式细胞仪检测单核细胞内TLR3的表达.结果 脓毒血症组TLR3[（55.1±30.2）％]、脓毒性心功能障碍组TLR3[（51.9±33.5）％]、非脓毒性心功能障碍组TLR3[（61.3±26.7）％]表达均较正常对照组儿童TLR3[（5.7±2.4）％]显著升高,差异均有统计学意义（均P＜ 0.01）;但3个病例组（脓毒血症组、脓毒性心功能障碍组和非脓毒性心功能障碍组）间TLR3水平比较,差异均无统计学意义（均P＞0.05）.结论 TLR3信号通路的激活可能是脓毒血症及心功能障碍的重要机制,抑制TLR3的过度表达可能成为减轻脓毒血症和心功能障碍潜在的治疗靶点.

Objective To study the expression and clinical signifcance of Toll-like receptor 3 （TLR3） in children with septic cardiac dysfunction. Methods A prospective controlled study was conducted. All cases were enrolled from pediatric department of Shantou Central Hospital from October, 2015 to March, 2017 and were divided into a sepsis group（S group, 20 cases）, a sepsis-induced cardiac dysfunction group（SCD group, 24 cases）, a non-septic cardiac dysfunction group （NSCD group, 10 cases）, and a healthy control group （Ctl group, 30 children）. The peripheral blood samples of 2 ml were collected within 24 hours of admission; the levels of TLR3 in all these groups were measured by flow cytometry. Results Compared with the healthy control group[（5.7±2.4%）], the level of TLR3 expression was markedly higher in the sepsis group [（55.1±30.2）%], the septic cardiac dysfunction group [（51.9±33.5）%], and the non-septic cardiac dysfunction group [（61.3±26.7）%], and the difference was statistically signifcant （P〈0.01）, but there were no signifcant differences in the expression of TLR3 among the various case groups （P〉0.05）. Conclusion Activation of TLR3 signaling pathway may be an important mechanism of sepsis and consequent cardiac dysfunction. Inhibition of TLR3 over expression may be a potential therapeutic target to alleviate sepsis and cardiac dysfunction.