高血压脑出血并发肺部感染患者TLR7 mRNA和IL-23与IL-17及其预测价值

TLR7 mRNA,IL-23 and IL-17 in patients with hypertensive cerebral hemorrhage complicated with pulmonary infection and their predictive value

目的探讨高血压脑出血(HCH)并发肺部感染患者Toll样受体7(TLR7)和白细胞介素-23(IL-23)与IL-17及其预测价值.方法回顾性收集2020年1月-2022年5月江西省吉安市中心人民医院收治的387例HCH患者临床资料,将其分为发生肺部感染的感染组(77例)和未发生肺部感染的非感染组(310例);比较两组血清TLR7、IL-23、IL-17信号通路指标水平,分析HCH患者并发肺部感染的危险因素;血清TLR7 mRNA、IL-23、IL-17对HCH患者并发肺部感染的预测价值.结果感染组TLR7 mRNA、IL-17、IL-23高于非感染组(P<0.05);吸烟史、合并慢性阻塞性肺疾病、入院格拉斯哥昏迷(GCS)评分、入院后持续颅内高压及血清TLR7 mR-NA是HCH患者并发肺部感染的危险因素(P<0.05);TLR7 mRNA、IL-23、IL-17联合预测HCH患者并发肺部感染的曲线下面积(AUC)、敏感度高于三者单独检测(P<0.05);IL-17敏感度高于TLR7、IL-23(P<0.05);联合检测特异度高于TLR7、IL-17(P<0.05).结论HCH患者并发肺部感染危险因素有吸烟史、合并慢性阻塞性肺疾病、入院GCS评分、入院后持续颅内高压及血清TLR7 mRNA,同时TLR7 mRNA、IL-23、IL-17联合对HCH患者并发肺部感染具有较高的预测价值.

OBJECTIVE To investigate Toll-like receptor 7(TLR7),interleukin-23(IL-23)and IL-17 in patients with hypertensive cerebral hemorrhage(HCH)complicated with pulmonary infection and their predictive value.METHODS The clinical data of 387 patients with HCH admitted to the Central People's Hospital of Ji'an,Jiangxi Province from Jan.2020 to May 2022 were retrospectively collected,and the patients were divided into an infected group(77 cases)with pulmonary infection and a non-infected group(310 cases)without pulmonary infection.The levels of serum TLR7,IL-23 and IL-17 signaling pathway indicators were compared between the two groups,and the risk factors of HCH patients complicated with pulmonary infection were summarized.The predictive value of serum TLR7 messenger ribonucleic acid(mRNA),IL-23 and IL-17 for HCH patients complicated with pulmonary infection were analyzed.RESULTS The levels of TLR7 mRNA,IL-17 and IL-23 in the infected group were higher than those in the uninfected group(P<o.05).Smoking history,chronic obstructive pulmonary disease,Glasgow coma scale(GCS)after admission,persistent intracranial hypertension after admission and serum TLR7 mRNA level were the risk factors of pulmonary infection in patients with HCH(P<0.05).The area under the curve(AUC)and sensitivity of the combined detection of TLR7 mRNA,IL-23 and IL-17 to predict concurrent pulmonary infection in patients with HCH were higher than that of the three indicators alone(P<0.05).The sensitivity of IL-17 was higher than that of TLR7 and IL-23(P<0.05).The specificity of combined detection was higher than that of TLR7 and IL-17(P<0.05).CONCLUSION The risk factors of concurrent pulmonary infection in patients with HCH were smoking history,chronic obstructive pulmonary disease,GCS score at admission,persistent intracranial hypertension after admission and serum TLR7 mRNA.At the same time,the combination of TLR7 mRNA,IL-23 and IL-17 had a good predictive value for concurrent pulmonary infection in patients with HCH.