外周血TLR2、PRF及GrzB在儿童嗜血细胞综合征中的表达及其与预后的关系

Expressions of TLR2,PRF and GrzB in peripheral blood in hemophagocytic syndrome in children and their relationship with prognosis

目的:探讨外周血Toll样受体2(TLR2)、NK细胞表面穿孔素(PRF)及颗粒酶B(GrzB)在儿童嗜血细胞综合征中的表达及与预后关系。方法:选取2019年1月至2021年1月昆明市儿童医院收治的79例嗜血细胞综合征儿童作为观察组,另纳入79例同龄体检健康儿童作为对照组。采用实时荧光定量聚合酶链式反应(RT-qPCR)法测定外周血TLR2基因表达量,流式细胞仪测定NK细胞表面PRF、GrzB阳性细胞率。受试者工作特征曲线(ROC)分析TLR2、PRF及GrzB的诊断效能,观察组接受为期6个月的随访,比较死亡组与存活组外周血TLR2水平及NK细胞表面PRF、GrzB阳性细胞率,Logistic回归法分析TLR2、PRF及GrzB三者交互作用对儿童嗜血细胞综合征预后的影响。结果:观察组外周血TLR2表达水平高于对照组,NK细胞表面PRF、GrzB阳性细胞率低于对照组(P<0.05);外周血TLR2表达水平及NK细胞表面PRF、GrzB联合诊断儿童嗜血细胞综合征价值明显优于单一诊断;死亡组外周血TLR2表达水平高于存活组,NK细胞表面PRF、GrzB阳性细胞率低于存活组(P<0.05);低TLR2与高NK细胞表面PRF、GrzB存在交互作用(P<0.05)。结论:外周血TLR2表达及NK细胞表面PRF、GrzB阳性细胞率联合检测有助于提高儿童嗜血细胞综合征的诊断效能,且与患儿预后存在交互作用,有助于早期发现和治疗。

Objective:To investigate the expressions of toll-like receptor 2(TLR2),NK cell surface perforin(PRF)and granulozyme B(GrzB)in hemophagocytic syndrome in children and their relationship with prognosis.Methods:Seventy-nine children with hemophagocytic syndrome admitted to Kunming Children’s Hospital from January 2019 to January 2021 were selected as the observation group,and another 79 healthy children of the same age with physical examination were included as the control group.TLR2 gene expression in peripheral blood was determined by real-time fluorescence quantitative polymerase chain reaction(RT-qPCR),and the rate of PRF and GrzB positive cells on the surface of NK cells was determined by flow cytometry.The diagnostic efficacy of TLR2,PRF and GrzB was analyzed by receiver operating characteristic curve(ROC).The observation group was followed up for 6 months,and patients’peripheral blood TLR2 levels and the rate of PRF and GrzB positive cells on the surface of NK cells were compared between the death group and the survival group.Logistic regression was used to analyse the effect of the interaction of TLR2,PRF and GrzB on the prognosis of haemophagocytic syndrome in children.Results:In the observation group,the peripheral blood TLR2 level was higher than that in the control group,and the rate of NK cell surface PRF and GrzB positive cells was lower than that in the control group(P<0.05);the expression level of TLR2 in peripheral blood and PRF and GrzB on the surface of NK cells combined in the diagnosis of hemophagocytic syndrome in children was significantly better than the single diagnosis;the expression level of TLR2 in peripheral blood of the death group was lower than that in the survival group,and the rate of PRF and Grz B positive cells on the NK cell surface was higher than that in the survival group(P<0.05);there was an interaction between low TLR2 and high NK cell surface PRF and Grz B(P<0.05).Conclusion:The combined detection of TLR2 expression in peripheral blood and the rate of PRF and Grz B positive cells on the surface of NK cells can improve the diagnostic efficiency of hemophagocytic syndrome in children,and interact with the prognosis of children,which is conducive to early detection and treatment.