不同病情程度脓毒症患者血清TLR4、APN水平变化的临床意义

Clinical significance of changes of serum TLR4 and APN levels in patients with sepsis of different severity

目的:探讨不同病情程度脓毒症患者血清Toll样受体4(toll like receptor 4,TLR4)、脂联素(adiponectin,APN)水平变化的临床意义。方法:选取2018年2月~2020年9月我院脓毒症患者96例作为观察组,其中脓毒症41例,严重脓毒症29例,脓毒性休克26例,同期肺部感染者71例作为对照Ⅰ组,健康体检者71例作为对照Ⅱ组。检测血清TLR4、APN水平,对比三组血清TLR4、APN水平及观察组脓毒症、严重脓毒症、脓毒性休克不同病情程度患者的一般资料、血清TLR4、APN水平,分析脓毒症病情程度与血清TLR4、APN水平关系及临床价值。结果:随病情加重,血清TLR4水平呈升高趋势,血清APN水平呈降低趋势,差异有统计学意义(P<0.05);不同病情程度患者体温、血清降钙素原水平、血清TLR4、APN水平对比,差异有统计学意义(P<0.05);经Spearman秩相关系数分析,脓毒症病情程度与血清TLR4水平呈正相关,与血清APN水平呈负相关(P<0.05);采用多元线性回归模型控制体温、血清降钙素原水平等混杂因素后,血清TLR4、APN水平仍与脓毒症病情程度有关(P<0.05)。结论:脓毒症患者血清TLR4、APN水平变化与病情程度呈独立显著相关,检测其水平变化有助于及时了解病情,为临床制定治疗方案提供参考。

Objective:To investigate the clinical significance of changes in serum toll like receptor 4(TLR4)and adiponectin(APN)levels in patients with sepsis of different severity.Methods:96 cases of sepsis patients in our hospital from February 2018 to September 2020 were selected as the observation group,including 41 cases of sepsis,29 cases of severe sepsis,and 26 cases of septic shock.71 cases of pulmonary infection in the same period were selected as the control group I,and 71 cases of healthy people as the control group II.The levels of serum TLR4 and APN were detected.The serum TLR4 and APN levels of the three groups and the general data,serum TLR4 and APN levels of patients with sepsis,severe sepsis,and septic shock in the observation group were compared.The relationship between the severity of sepsis and serum TLR4 and APN levels and its clinical value were analyzed.Results:With the worsening of the disease,the serum TLR4 level showed an increasing trend,and the serum APN level showed a decreasing trend,and the difference was statistically significant(P<0.05).There were statistically significant differences in body temperature,serum procalcitonin levels,serum TLR4,and APN levels of patients with different disease levels(P<0.05).According to Spearman rank correlation coefficient analysis,the severity of sepsis was positively correlated with serum TLR4 level,and negatively correlated with serum APN level(P<0.05).After the multiple linear regression model was used to control confounding factors such as body temperature and serum procalcitonin level,serum TLR4 and APN levels were still related to the severity of sepsis(P<0.05).Conclusion:The changes in serum TLR4 and APN levels in patients with sepsis are independently and significantly related to the severity of the disease.The detection of changes in their levels can help to understand the disease in time and provide references for clinical treatment plans.