多药耐药革兰阴性菌感染脓毒症患者TLR4及内毒素变化与病情发展的关系

Relationship between changes of TLR4 and endotoxin and disease progression in patients with sepsis caused by multi-drug resistant Gram-negative bacteria infection

目的探讨多药耐药(MDR)革兰阴性菌感染脓毒症患者Toll样受体(TLR)4、内毒素变化与病情发展的关系。方法回顾性分析2018年9月-2020年9月医院救治的130例革兰阴性菌感染的脓毒症患者一般临床资料,对患者进行病原菌及耐药性分析,并根据患者是否表现为MDR分为MDR组及非MDR组,分析TLR4、内毒素变化情况,另根据MDR脓毒症病情发展情况分为脓毒血症组、脓毒性休克组,探讨TLR4、内毒素变化情况及与序贯器官衰竭(SOFA)评分、急性生理与慢性健康(APACHE)Ⅱ评分相关性,随访记录MDR革兰阴性菌感染脓毒症患者病情进展,并进一步分析以上指标与病情进展相关性。结果130例患者共检出179株革兰阴性菌,以大肠埃希菌为主(39.11%);130例革兰阴性菌感染脓毒症患者中45例MDR革兰阴性菌感染,85例非MDR革兰阴性菌感染,且MDR革兰阴性菌感染者TLR4、内毒素、SOFA评分、APACHEⅡ评分均高于非MDR革兰阴性菌感染者(P<0.05);脓毒性休克组TLR4、内毒素、SOFA评分、APACHEⅡ评分高于脓毒血症组(P<0.05);死亡组入院时TLR4、内毒素、SOFA评分、APACHEⅡ评分均高于存活组(P<0.05)。结论MDR革兰阴性菌感染脓毒症患者TLR4、内毒素明显升高,参与疾病进展,亦可为预后评估提供客观依据,在早期监测MDR感染及预后评估中具有重要意义。

OBJECTIVE To investigate the relationship between changes of Toll-like receptor(TLR)4 and endotoxin and disease progression in patients with sepsis caused by multi-drug resistant(MDR)Gram-negative bacteria(G-bacteria)infection.METHODS The general clinical data of 130 patients with sepsis caused by G-bacteria infection treated in the hospital were retrospectively analyzed between Sep 2018 and Sep 2020.The pathogenic bacteria and drug resistance were analyzed.The patients were divided into the MDR group(n=45)and non-MDR group(n=85)according to whether they presented with MDR.Changes of TLR4 and endotoxin were analyzed.According to disease development,patients with MDR sepsis were divided into the pyemia group and septic shock group.The correlation of TLR4 and endotoxin changes with SOFA score and APACHEⅡscore were analyzed.Disease progression of patients with sepsis caused by MDR G-bacteria was recorded.The correlations between the above indicators and disease progression were analyzed.RESULTS A total of 179 strains of G-bacteria were detected in the 130 patients,and Escherichia coli was the main pathogenic bacteria(39.11%).Forty-five of the 130 patients had MDR G-bacteria infection,and 85 were infected by non-MDR G-bacteria.TLR4,endotoxin,SOFA score and APACHEⅡscore in the MDR group were significantly higher than those in the non-MDR group(P<0.05).The above indicators in the septic shock group were significantly higher than those in the pyemia group(P<0.05).TLR4,endotoxin,SOFA score and APACHEⅡscore in the death group at admission were significantly higher those in the survival group(P<0.05).CONCLUSION TLR4 and endotoxin are elevated in patients with sepsis caused by MDR G-bacteria infection,and participate in disease progression.Both of the indexes have great significance for early monitoring of MDR infection and prognosis evaluation.