恶性梗阻性黄疸经内镜胆道内置管引流术后胆道感染TLRs/MyD88/NF-κB信号通路表达

Expressions of TLRs-MyD88-NF-kB signaling pathways in malignant obstructive jaundice patients with biliary tract infection after endoscopic retrograde biliary drainage

目的分析恶性梗阻性黄疸经内镜胆道内置管引流术(ERBD)后胆道感染状况,并探讨Toll样受体(TLRs)/髓样分化蛋白88(Myd88)/核因子κB(NF-κB)信号通路表达变化及意义。方法选取2020年4月-2021年6月于河北北方学院附属第一医院行ERBD术的低位恶性梗阻性黄疸患者120例为研究对象,根据患者术后是否发生胆道感染分为感染组和非感染组,采集患者术后空腹静脉血,检测血清白细胞介素(IL)-1β、IL-6、降钙素原(PCT),分离外周血单个核细胞(PBMCs)并检测TLR2、TLR4、Myd88和NF-κB(p65)mRNA相对表达水平。结果120例行ERBD术的低位恶性梗阻性黄疸患者中,术后胆道感染率为15.00%(18/120),共培养分离病原菌23株,其中革兰阴性菌18株占78.28%;感染组患者PMBCs中TLR2、TLR4、Myd88、NF-κB(p65)mRNA相对表达水平均高于非感染组(P<0.05);感染组患者血清PCT、IL-1β及IL-6水平均高于非感染组(P<0.05);受试者工作特征(ROC)曲线分析显示,IL-1β、IL-6诊断ERBD术后胆道感染的曲线下面积(AUC)均>0.7。结论ERBD术后胆道感染患者TLR2/4-MyD88-NF-κB信号通路激活并引起外周血IL-1β、IL-6水平异常升高,IL-1β、IL-6对ERBD术后胆道感染诊断价值较高。

OBJECTIVE To investigate the prevalence of postoperative biliary tract infection in malignant obstructive jaundice patients undergoing endoscopic retrograde biliary drainage(ERBD)and explore the expressions of Tolllike receptor(TLRs)/myeloid differentiation protein 88(Myd88)/nuclear factor kappa B(NF-kB)signaling pathways.METHODS A total of 120 patients with low malignant obstructive jaundice who underwent ERBD in the First Affiliated Hospital of Hebei North University from Apr 2020 to Jun 2021 were recruited as the research subjects and were divided into the infection group and the non-infection group according to the status of postoperative biliary tract infection.The fasting venous blood specimens were collected from the patients after surgery,the serum interleukin(IL)-1β,IL-6 and procalcitonin(PCT)were detected.The peripheral blood mononuclear cells(PBMCs)were isolated to detect the relative expression levels of TLR2,TLR4,Myd88 and nuclear factor-kB(p65)mRNA.RESULTS The incidence rate of postoperative biliary tract infection was 15.00%(18/120)among the 120 low malignant obstructive jaundice patients undergoing ERBD.Totally 23 strains of pathogens were isolated,18(78.28%)of which were gram-negative bacteria.The relative expression levels of TLR2,TLR4,Myd88 and NF-kB(p65)mRNA in PBMCs were higher in the infection group than in the non-infection group(P<0.05).The levels of serum PCT,IL-1βand IL-6 of the infection group were higher than those of the non-infection group(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that areas under curves(AUCs)of both IL-1βand IL-6 were more than O.7 in diagnosis of postoperative biliary tract infection in the ERBD patients.CONCLUSION The postoperative biliary tract infection may activate the TLR2/4-MyD88-NF-cB signaling pathways and lead to the abnormal rise of peripheral blood IL-1βand IL-6 level of the ERBD patients.The IL-1βand IL-6 have high value in diagnosis of postoperative biliary tract infection in the ERBD patients.