近端胃切除术后并发腹腔感染外周血TLR2、TLR4和Th1/Th2表达及其与临床转归的关系

Expressions of TLR2,TLR4 and Th1/Th2 in peripheral blood of proximal gastrectomy patients complicated with postoperative abdominal infection and association with clinical outcomes

目的探讨近端胃切除术后并发腹腔感染患者Toll样受体(TLR)2、TLR4和辅助性T淋巴细胞(Th)1/Th2表达及其与临床转归的关系。方法选取2020年1月-2022年12月邢台市人民医院行近端胃切除术后并发腹腔感染的83例胃癌患者为感染组,另选取同期行近端胃切除术后无腹腔感染的83例胃癌患者为未感染组。对比两组外周血TLR2 mRNA、TLR4 mRNA及Th1/Th2比值。对患者以电话、门诊复查形式随访1年,根据临床转归将感染组患者分为转归良好组和转归不良组,分析TLR2 mRNA、TLR4 mRNA、Th1/Th2与近端胃切除术后并发腹腔感染患者转归不良的关系及对近端胃切除术后并发腹腔感染患者临床转归不良的预测价值。结果感染组外周血TLR2 mRNA、TLR4 mRNA高于未感染组(P<0.05);Th1/Th2比值低于未感染组(P<0.05)。外周血TLR2 mRNA、TLR4 mRNA及Th1/Th2比值与近端胃切除术后并发腹腔感染患者临床转归有关(P<0.05)。外周血TLR2 mRNA、TLR4 mRNA及Th1/Th2比值联合预测近端胃切除术后并发腹腔感染患者临床转归不良的曲下线面积为0.965,高于三指标单独检测(P<0.05)。结论外周血TLR2、TLR4、Th1/Th2在近端胃切除术后并发腹腔感染患者中异常表达,三指标异常表达与患者转归不良有关。

OBJECTIVE To explore the expressions of Toll-like receptor(TLR)2,TLR4 and helper T(Th)lymphocyte/Th2 in peripheral blood of the proximal gastrectomy patients complicated with postoperative abdominal infection and analyze the association with clinical outcomes.METHODS Totally 83 patients with gastric caner who underwent proximal gastrectomy and were complicated with postoperative abdominal infection in Xingtai People′s Hospital from Jan.2020 to Dec.2022 were assigned as the infection group,meanwhile,83 gastric cancer patients who underwent proximal gastrectomy but were not complicated with postoperative were assigned as the no infection group.The peripheral blood TLR2 mRNA,TLR4 mRNA and Th1/Th2 ratio were compared between the two groups.The follow-up was conducted by phone calls and outpatient visit for reexamination.The patients of the infection group were divided into the favorable prognosis group and the poor prognosis group according to the clinical outcomes.The association between the TLR2 mRNA,TLR4 mRNA,Th1/Th2 and the poor prognosis was observed,and the values of the indexes in prediction of poor clinical outcomes of the proximal gastrectomy patients complicated with postoperative abdominal infection were observed.RESULTS The peripheral blood TLR2 mRNA and TLR4 mRNA of the infection group were significantly higher than those of the no infection group(P<0.05).The Th1/Th2 ratio of the infection group was significantly lower than that of the no infection group(P<0.05).The peripheral blood TLR2 Mrna,TLR4 mRNA and Th1/Th2 ratio were associated with the clinical outcomes of the proximal gastrectomy patients complicated with postoperative abdominal infection(P<0.05).The area under the curve of the joint detection of peripheral blood TLR2 mRNA,TLR4 mRNA and Th1/Th2 ratio was 0.965 in prediction of the poor clinical outcomes of the proximal gastrectomy patients complicated with postoperative abdominal infection,significantly higher than that of the single detection(P<0.05).CONCLUSION The proximal gastrectomy patients complicated with postoperative abdominal infection show the abnormal expressions of peripheral blood TLR2,TLR4 and Th1/Th2,which is associated with the poor prognosis of the patients.