血清TLR4、NF-κB在劳力性热射病患者中的表达及临床意义

Expression and clinical significance of serum TLR4 and NF-κB in patients with exertional heat stroke

目的探讨血清Toll样受体-4(TLR4)、核转录因子-κB(NF-κB)在劳力性热射病(EHS)患者中的表达及其对患者预后的预测价值。方法选取2017年1月—2019年4月期间在联勤保障部队第九00医院接受治疗的EHS患者51例作为EHS组,根据患者的预后情况分为预后不良组(11例)、预后良好组(40例)。另选取同期在我院体检的健康志愿者51例作为对照组。采用酶联免疫吸附法检测血清中TLR4、NF-κB、肿瘤坏死因子-ɑ(TNF-ɑ)、白介素-1β(IL-1β)、白介素-6(IL-6)的水平,记录患者的急性生理与慢性健康评分-Ⅱ(APACHE-Ⅱ)评分。结果EHS组患者的血清TLR4、NF-κB、TNF-ɑ、IL-1β、IL-6水平及APACHE-Ⅱ评分高于对照组(P<0.05);预后不良组患者的血清TLR4、NF-κB、TNF-ɑ、IL-1β、IL-6水平及APACHE-Ⅱ评分高于预后良好组(P<0.05);EHS患者血清TLR4、NF-κB与TNF-ɑ、IL-1β、IL-6、APACHE-Ⅱ评分均呈正相关(P<0.05);ROC分析显示,TLR4的曲线下面积为0.705(95%CI:0.547~0.862),NF-κB的曲线下面积为0.691(95%CI:0.528~0.854),APACHE-Ⅱ评分的曲线下面积为0.830(95%CI:0.706~0.953),三者联合检测,可进一步提高特异度和约登指数。结论血清TLR4、NF-κB在EHS患者中异常高表达,且其表达水平与炎症反应、APACHE-Ⅱ评分呈正相关,APACHE-Ⅱ评分联合血清TLR4、NF-κB可提高对EHS患者预后的预测价值。

Objective To investigate the expression of serum Toll-like receptors-4(TLR4)and nuclear factor kappa B(NF-κB)in patients with exertional heat stroke(EHS)and their predictive value for patient prognosis.Methods A total of 51 EHS patients who underwent treatment in 9th 00 Hospital from January 2017 to April 2019 were enrolled in the EHS group.According to the prognosis of the patients,they were divided into a poor prognosis group(11 cases)and a good prognosis group(40 cases).Another 51 healthy volunteers who were examined in our hospital during the same period were selected as the control group.Serum TLR4,NF-κB,tumor necrosis factor-ɑ(TNF-ɑ),interleukin-1β(IL-1β)and interleukin-6(IL-6)were detected by enzyme-linked immunosorbent assay.Patients'Acute Physiology and Chronic Health Evaluation(APACHE-Ⅱ)scores were recorded.Results The levels of serum TLR4,NF-κB,TNF-ɑ,IL-1β,IL-6,and the APACHE-Ⅱscore in the EHS group were significantly higher than those in the control group(P<0.05).The levels of serum TLR4,NF-κB,TNF-ɑ,IL-1β,IL-6,and the APACHE-Ⅱscore in the poor prognosis group were significantly higher than those in the good prognosis group(P<0.05).Serum TLR4 and NF-κB were positively correlated with TNF-ɑ,IL-1β,IL-6 and APACHE-Ⅱscores in EHS patients(P<0.05).ROC analysis showed that the area under the curve of TLR4 was 0.705(95% CI:0.547-0.862),the NF-κB was 0.691(95%CI:0.528-0.854),and the APACHE-Ⅱscore was 0.830(95% CI:0.706-0.953),combined detection of the three,can further improve the specificity and the Yoden index.Conclusion Serum TLR4 and NF-κB are highly expressed in EHS patients,and their expression levels are positively correlated with inflammatory response and APACHE-Ⅱscore.APACHE-Ⅱscore combined with serum TLR4 and NF-κB can improve the predictive value of prognosis in patients with EHS.