原发性脑出血患者外周血中TLR2的动态变化及意义

Dynamic changes and significance of TLR2 in peripheral blood of patients with primary cerebral hemorrhage

目的探讨原发性脑出血患者外周血中（toll-likereceptor2，TLR2）的水平变化，从而评估患者病情严重程度及预后的临床价值。方法选择2015年1月-2017年1月中南大学湘雅医学院附属海口医院收治的50例原发性脑出血患者（脑出血组）与同期健康体检者50例作为正常对照组，其中脑出血组均为发病2h就诊，按发病距采血时间分为2h组，24h组，72h组，7d组，各组分别采用酶联免疫吸附测定法（enzyme-linkedimmunosorbentassay，ELISA）。检测其外周血中（toll-likereceptor2，TLR2）的水平，同时记录各时间点的卒中量表（nationalinstituteofhealthstrokescale，NIHSS）及脑出血量，并于发病后90d行改良RANKIN量表（modifiedrankinscale，mRS）评分采用Logistic回归分析TLR2的表达与预后的关系。结果①各实验组外周血清中TLR2的表达均高于对照组（t=7．147，t=3．979，t=8．894，t=5．378），差异均有统计学意义（P〈0．05）；72h组TLR2的表达高于其他组，差异有统计学意义；②各时间点血清TLR2水平随着出血量的增多而增高；③各时间点血清TLR2水平随着神经功能缺损程度加重而增高，差异有统计学意义（P〈0．05）；④ROC曲线分析示，血清TLR2的截断点为148．85ng／mL，曲线下面积为0．836，灵敏度91．7％，特异度为73．2％。Logistic回归分析显示TLR2的表达〉148．85ng／mL（OR=1．04，95％CI=0．62～1．78）、脑出血量（OR=1．67，95％CI=1．12～4．25）NIHSS评分（OR=0．78，95％CI=0．57—1．23）是原发性脑出血患者独立预后危险因素之一。结论TLR2参与了脑出血的病理生理过程，与脑出血量、神经功能损伤密切相关，可作为评估脑出血患者预后的参考指标之一。

Objective To evaluate the dynamic changes and significance of Toll-like receptor 2 （TLR2） in peripheral blood of patients with primary cerebral hemorrhage. Methods Fifty patients withprimary cerebral hemorrhage from Haikou hospitalwere selected as the observation group. At the same time, 50 patients with healthy physical examinations were set as thecontrol group. The TLR2 levels from the peripheral blood were detected at 2h, 24h, 72h and 7days in both groups. The NIHSS score and cerebral hemorrhage volume were recorded. The levels of TLR2 in patients with different nerve function defects were compared.All patients were scored at 90 days by modified Rankin scale （mRS） to evaluate the prognosis. Logistic regression was used to analyze the relationship between expression and prognosis of TLR2. Results There was a significant difference in the LR2 levels in the peripheral blood of each time points than that in the control group （t= 7.147,t= 3.979,t= 8.894,t= 5.378）, （P〈 0.05）. The expression of TLR2 in 72hwas higher than that of other time points,（P〈 0.05）. The TLR2 increased with the increase of blood volume and the degree of neurological impairment at each time point; （P〈 0.05）. The truncation point of the serum TLR2 was 148.85ng/ ml, the area of the curve was 0.836, the sensitivity was 91.7% and the specificity was 73.2%. Logistic regressionanalysis showed that TLR2 expression 〉148.85ng/ml （OR=l.04, 95%CI=0.62-1.78）, cerebral hemorrhage （OR=1.67, 95%CI=1.12-4.25） NIHSS score （OR=0.78, 95%CI= 0.57-1.23） was one of the independent prognostic risk factors for patients with primary cerebral hemorrhage; Conclusion TLR2 may be involved in the pathophysiological process of cerebral hemorrhage which is closely related to the amount of cerebral hemorrhage and nerve function injury, and can be used as one of the indexes to evaluate the prognosis of patients with cerebral hemorrhage.