血液滤过对重症感染性休克患者单个核细胞Toll样受体4/核因子-κB通路活化的影响

Effect of hemofiltration on TLR4/NF-κB pathway activation in mononuclear cells of patients with se⁃vere septic shock

目的研究血液滤过对重症感染性休克患者外周血单个核细胞(peripheral blood mononuclear cells,PBMCs)Toll样受体4(toll like receptor 4,TLR4)/核因子-κB(nuclear factor-κB,NFκB)通路活化的影响。方法选择2019年1月至2020年12月期间华北理工大学附属医院收治的重症感染性休克患者进行回顾性对照研究,根据是否接受血液滤过治疗分为常规治疗的对照组(n=59)、常规治疗联合血液滤过的实验组(n=38)。治疗前及治疗后72 h,比较2组患者心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)、中心静脉压(central venous pressure,CVP)、血清肿瘤坏死因子α(serum tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)、细胞间黏附分子-1(in⁃tercellular adhesion molecule-1,ICAM-1)含量、PBMCs中TLR4及NF-κB表达水平、28 d累积病死率的差异。结果治疗后72 h,2组患者的HR、血清TNF-α、IL-6、ICAM-1含量、PBMCs中TLR4及NF-κB表达水平均较治疗前降低,MAP、CVP均较治疗前升高(P<0.05)且实验组患者的HR、血清TNF-α、IL-6、ICAM-1含量、PBMCs中TLR4及NF-κB表达水平及28 d累计病死率均低于对照组,MAP、CVP均高于对照组(P<0.05)。结论血液滤过对重症感染性休克患者的休克状态、炎症反应及28 d生存具有改善作用,抑制TLR4/NF-κB通路是血液滤过发挥上述改善作用可能的分子机制。

Objective To explore the effect of hemofiltration on Toll like receptor 4(TLR4)/nuclear factor pathway activation in peripheral blood mononuclear cells(PBMCs)of patients with severe septic shock.Methods From January 2019 to December 2020,hospitalized patients with severe septic shock were recruited for this retrospective control study.Control group was treated routinely(n=59)while experimental group received routine treatment plus hemofiltration(n=38).Before and 72h after treatment,the difference of heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP)and serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),intercellular adhesion mol⁃ecule-1(ICAM-1),TLR4/NF-κB expression level in peripheral blood mononuclear cells(PBMCs)and 28-day cumulative mortality were compared.Results At 72h post-treatment,HR and serum levels of TNF-α,IL-6,ICAM-1,TLR4 and NF-κB declined in both groups while MAP and CVP were higher than those pre-treatment(P<0.05);HR,TNF-α,IL-6,ICAM-1,TLR4 and NF-κB and 28-day cu⁃mulative mortality were lower in experimental group than those in control group;MAP and CVP were higher than those of control group(P<0.05).Conclusion Hemofiltration may improve shock state,blunt inflammatory responses and boost 28-day survival in patients with severe septic shock.And sup⁃pressing TLR4/NF-κB pathway is a probable molecular mechanism of hemofiltration.