应激性高血糖与青年脑梗死患者肺部感染和TLR4/NF-κB信号通路及细胞免疫功能的关系

Relationship of stress hyperglycemia with pulmonary infection,TLR4/NF-κB signaling pathway and cellular immune function in young patients with cerebral infarction

目的探讨应激性高血糖(SHG)与青年脑梗死患者肺部感染及Toll样受体4(TLR4)/核转录因子-κB(NF-κB)信号通路、细胞免疫功能的关系。方法选择2018年1月-2020年1月衡水市人民医院神经内科收治的首发青年脑梗死患者作为研究对象,根据入院后血糖水平将患者分为SHG组33例、非SHG组45例,根据是否发生肺部感染分为感染患者及非感染患者。感染患者进行病原菌分析及药敏试验,收集患者外周静脉血检测CD_(4)^(+)、CD_(8)^(+) T淋巴细胞亚群比例,检测TLR4、NF-κB表达。结果 25例感染患者共培养分离病原菌31株,其中革兰阴性菌21株占67.74%,革兰阳性菌9株占29.03%,真菌1株占3.23%;肺炎克雷伯菌、铜绿假单胞菌对氨苄西林、头孢唑林、环丙沙星、左氧氟沙星等药物耐药率较高,肺炎克雷伯菌对哌拉西林耐药率较高,未检出美罗培南、亚胺培南耐药株;金黄色葡萄球菌对青霉素、红霉素、克林霉素、四环素耐药率较高,未检出万古霉素耐药菌株。感染及非感染患者中分别有80.00%、24.53%患者发生SHG(P<0.05);感染患者TLR4、NF-κB mRNA表达高于非感染组,CD_(4)^(+) T淋巴细胞比例、CD_(4)^(+)/CD_(8)^(+)低于非感染组(P<0.05)。SHG组TLR4、NF-κB mRNA表达高于非SHG组,CD_(4)^(+) T淋巴细胞比例、CD_(4)^(+)/CD_(8)^(+)低于非SHG组(P<0.05);发生SHG、低蛋白血症是肺部感染发生的影响因素(P<0.05)。结论 SHG与青年脑梗死患者肺部感染及TLR4/NF-kB信号通路、细胞免疫功能密切相关,早期监测血糖变化及给予降血糖治疗非常重要。

OBJECTIVE To investigate the relationship of stress hyperglycemia(SHG) with pulmonary infection,Toll-like receptor 4(TLR4)/nuclear factor-kappa B(NF-kB) signaling pathway and cellular immune function in young patients with cerebral infarction.METHODS Totally 78 young patients with first-episode cerebral infarction treated in the Neurology Department of Hengshui People′s Hospital from Jan.2018 to Jan.2020 were selected as the research subjects,and were divided into 33 cases of SHG group and 45 cases of non-SHG group according to their blood glucose level after admission,and were divided into infected group and uninfected group according to the occurrence of pulmonary infection.Infected patients were subjected to pathogenic bacteria analysis and drug sensitivity test.Peripheral venous blood samples were collected to detect the proportions of CD_(4)^(+) and CD_(8)^(+) T lymphocyte subsets.Real-time fluorescent quantitative PCR was performed to detect the expression of TLR4 and NF-κB.RESULTS A total of 31 pathogenic strains were isolated from 25 infected patients,of which 21 strains of Gram-negative bacteria accounted for 67.74%,9 strains of Gram-positive bacteria accounted for 29.03%,and 1 strain of fungi accounted for 3.23%.Klebsiella pneumoniae and Pseudomonas aeruginosa were highly resistant to drugs such as ampicillin,cefazolin,ciprofloxacin,and levofloxacin,while K.pneumoniae was highly resistant to piperacillin.No meropenem and imipenem resistant strains were detected.Staphylococcus aureus was highly resistant to penicillin,erythromycin,clindamycin and tetracycline,and no vancomycin resistant strains were detected.There were 80.00% and 24.53% patients with SHG in the infected group and the uninfected group,respectively(P<0.05).The expression of TLR4 and NF-κB mRNA in the infected group was significantly higher than that in the uninfected group,while the ratio of CD_(4)^(+) T lymphocytes and CD_(4)^(+)/CD_(8)^(+) were significantly lower than those in the uninfected group(P<0.05).The expression of TLR4 and NF-κB mRNA in the SHG group was significantly higher than those in the non-SHG group,while the ratio of CD_(4)^(+) T lymphocytes and CD_(4)^(+)/CD_(8)^(+) were significantly lower than those in the non-SHG group(P<0.05).SHG and hypoproteinemia were the influencing factors of pulmonary infection(P<0.05).CONCLUSION SHG was closely related to pulmonary infection,TLR4/NF-kB signal pathway and cellular immune function in young patients with cerebral infarction.Early monitoring of changes in blood glucose and hypoglycemic treatment were very important.