重症肺炎肺泡灌洗液TLR4、TLR2、HMGB1表达水平变化及其预后评估价值分析

Levels changes of Toll-like receptor 4,Toll-like receptor 2 and high mobility group protein B1 in bronchoalveolar lavage fluid and their evaluation value for prognosis in severe pneumonia

目的探讨重症肺炎(SP)肺泡灌洗液(BALF)Toll样受体4(TLR4)、Toll样受体2(TLR2)、高迁移率族蛋白B1(HMGB1)表达水平变化及其对SP患者预后的评估价值。方法选取本院2019年10月—2021年9月176例SP患者作为SP组,根据预后情况分为生存组(n=128)和死亡组(n=48),另取同期收治的120例普通肺炎患者作为普通肺炎组。检测并比较所有受试者BALF中TLR4、TLR2、HMGB1表达水平、临床肺部感染评分(CPIS)及急性生理功能与慢性健康(APACHEⅡ)评分,采用Pearson相关系数分析BALF中TLR4、TLR2、HMGB1表达水平与CPIS及APACHEⅡ评分的相关性,采用受试者工作特征曲线(ROC)分析BALF中TLR4、TLR2、HMGB1表达水平对SP患者预后的评估价值。结果SP组BALF中TLR4、TLR2、HMGB1表达水平均高于普通肺炎组(P<0.05);SP组CPIS评分及APACHEⅡ评分均高于普通肺炎组(P<0.05);Pearson相关性分析结果显示,BALF中TLR4、TLR2、HMGB1表达水平与CPIS及APACHEⅡ评分均成正相关(P<0.05);死亡组BALF中TLR4、TLR2、HMGB1表达水平均高于生存组(P<0.05);由ROC曲线可知,BALF中TLR4、TLR2、HMGB1表达水平联合评估SP患者预后的AUC为0.892,高于三者单独评估的0.747、0.742、0.772(P<0.05)。结论TLR4、TLR2、HMGB1在SP患者BALF中呈高表达水平,且三者与SP患者病情及预后存在相关性,临床可将TLR4、TLR2、HMGB1作为评估SP患者预后的参考指标。

Objective To explore the changes in levels of Toll-like receptor 4(TLR4),Toll-like receptor 2(TLR2)and high mobility group protein B1(HMGB1)in bronchoalveolar lavage fluid(BALF)and their evaluation value for prognosis of patients with severe pneumonia(SP).Methods A total of 176 patients with SP in the hospital were enrolled as SP group between October 2019 and September 2021.According to different prognosis,they were divided into survival group(n=128)and death group(n=48).A total of 120 patients with common pneumonia during the same period were enrolled as common pneumonia group.The levels of TLR4,TLR2 and HMGB1 in BALF,clinical pulmonary infection score(CPIS)and acute physiological function and chronic health score(APACHEⅡ)in all objects were detected and compared.The correlation between TLR4,TLR2,HMGB1 and CPIS,APACHEⅡwas analyzed by Pearson correlation coefficient.The evaluation value of TLR4,TLR2 and HMGB1 for prognosis of SP patients was analyzed by receiver operating characteristic curve(ROC).Results The levels of TLR4,TLR2 and HMGB1 in BALF in SP group were higher than those in common pneumonia group(P<0.05),CPIS and APACHEⅡwere higher than those in common pneumonia group(P<0.05).The results of Pearson correlation analysis showed that the levels of TLR4,TLR2 and HMGB1 in BALF were positively correlated with CPIS and APACHEⅡ(P<0.05).The levels of TLR4,TLR2 and HMGB1 in BALF in death group were higher than those in survival group(P<0.05).ROC showed that AUC of TLR4 combined with TLR2 and HMGB1 in evaluating prognosis of SP patients was 0.892,greater than that of single index(0.747,0.742,0.772)(P<0.05).Conclusion The levels of TLR4,TLR2 and HMGB1 in BALF are high in SP patients,and the three are related to conditions and prognosis of SP patients.Clinically,TLR4,TLR 2 and HMGB1 can be applied as reference indexes to evaluate the prognosis of SP patients.