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门静脉高压症脾功能亢进患者脾巨噬细胞Toll样受体4的表达及其意义
作者姓名:Li ZF  Zhang Y  Gao J  Zhang PJ  Wang JX  Liu XG
作者单位:1. 710004,西安交通大学第二医院普外科
2. 内蒙古医学院第一附属医院普外科
3. 710004,西安交通大学第二医院皮肤科实验室
基金项目:教育部优秀青年教师资助计划基金资助项目 ( 2 0 0 3年 ),陕西省科学技术发展计划基金资助项目( 2 0 0 3K10 G73 )
摘    要:目的通过观察门静脉高压症(PH)脾亢脾巨噬细胞(MΦ)的Toll样受体4(TLR4)表达变化,探讨其在脾亢发生中的作用.方法肝硬化PH脾亢患者20例(脾亢组),外伤性脾破裂患者6例(对照组).均收集其手术切除的脾脏标本,采用玻片贴壁法分离培养脾脏MΦ;免疫组化SABC法检测脾脏MΦTLR4的表达,图像分析系统分析结果;鸡红细胞吞噬法检测MΦ的吞噬功能;鲎试剂法检测患者血清内毒素水平.进行两组各项指标之间的比较,并对脾亢组各指标之间作相关性分析.结果脾MΦTLR4的表达量(免疫组化染色深度),脾亢组为109±32,对照组为62±5,两组差异有显著意义(P<0.01).脾MΦ的吞噬率及吞噬指数,脾亢组分别为12.6%±3.0%、0.146±0.035,对照组分别为6.9%±0.5%、0.076±0.008,两组差异有显著意义(P<0.01).血清内毒素水平,脾亢组为0.28 EU/ml±0.21 EU/ml,对照组为0.054 EU/ml±0.014 EU/ml,两组差异有显著意义(P<0.05).脾亢组MΦ吞噬率及吞噬指数,与TLR4的表达量显著正相关(r=0.601,P<0.01;r=0.553,P<0.05),与血清内毒素水平显著正相关(r=0.724,P<0.01;r=0.506,P<0.05),MΦTLR4的表达量与血清内毒素水平显著正相关(r=0.525,P<0.05).结论 PH脾亢脾MΦ的TLR4表达明显增多, "内毒素血症→脾脏MΦToll样受体活化→MΦ吞噬破坏血细胞增多"是PH脾亢发生的可能机制之一.

关 键 词:门静脉高压症  脾功能亢进  Toll样受体4  基因表达  脾巨噬细胞  吞噬功能  免疫组化

Expression and significance of Toll-like receptor 4 of splenic macrophage in patients with hypersplenism due to portal hypertension
Li ZF,Zhang Y,Gao J,Zhang PJ,Wang JX,Liu XG.Expression and significance of Toll-like receptor 4 of splenic macrophage in patients with hypersplenism due to portal hypertension[J].National Medical Journal of China,2004,84(13):1088-1091.
Authors:Li Zong-Fang  Zhang Yu  Gao Jun  Zhang Pan-Jian  Wang Ji-Xin  Liu Xiao-Gong
Institution:Department of General Surgery, The Second Hospital of Xi'an Jiaotong University, Xi'an 710004, China.
Abstract:OBJECTIVE: To observe the change in expression of Toll-like receptor 4 (TLR4) of splenic macrophage in patients with hypersplenism due to portal hypertension (PH), and investigate the role of TLR4 of splenic macrophage in hypersplenism. METHODS: Splenectomy was performed on 20 patients with hypersplenism due to PH (hypersplenism group) and 6 patients with rupture of spleen by trauma (control group) and the specimens of spleen were collected. The splenic macrophages were isolated by adhibit wall method. The expression of TLR4 of splenic macrophage was detected by immunohistochemical method (SABC), and the result was analyzed by the image analysis system. The phagocytosis of splenic macrophage was measured by chicken red blood cell (CRBC) phagocytosis assay. The level of serum endotoxin was detected before the operation by limulus assay. The results of these 2 groups were compared, and correlation analysis was made among different results of the hypersplenism group. RESULTS: The expression of TLR4 of splenic macrophage was 109 +/- 32 in the hypersplenism group, significantly higher than that of the control group (62 +/- 5, P < 0.01). The rate of phagocytosis and index of phagocytosis of splenic macrophage in the hypersplenism group were 12.6% +/- 3.0% and 0.146 +/- 0.035 respectively, both significantly higher than those of the control group (6.9% +/- 0.5% and 0.076 +/- 0.008 respectively, both P < 0.01) The level of endotoxin of the hypersplenism group was 0.28 EU/ml +/- 0.21 EU/ml, significantly higher than that of the control group (0.054 EU/ml +/- 0.014 EU/ml, P < 0.05). The rate of phagocytosis and the index of phagocytosis of splenic macrophage were notably positively correlated with the expression of TLR4 (r = 0.601, P < 0.01 and r = 0.553, P < 0.05), and the level of endotoxin (r = 0.724 P < 0.01 and r = 0.506, P < 0.05). The expression of TLR4 of splenic macrophage was positively correlated with the level of endotoxin (r = 0.525, P < 0.05). CONCLUSION: The expression of TLR4 of splenic macrophage in patients with hypersplenism due to PH was increased significantly. It may be one of the important factors of hypersplenism due to PH that "endotoxemia-->increase of expression of TLR4 of splenic macrophage (activation of TLR of splenic macrophage)-->increased destruction of red blood cells by macrophage".
Keywords:Hypertension  portal  Hypersplenism  Macrophage  Toll-like receptor 4
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