乌司他丁对创伤失血性休克患者外周血单核细胞TOLL样受体4表达的影响

目的:观察乌司他丁对创伤失血性休克患者外周血单核细胞TOLL样受体4表达的影响,从而进一步了解乌司他丁抑制炎症反应的作用机制。方法:创伤失血性休克患者60例随机分为对照组(n=30)和乌司他丁组(n=30),乌司他丁组在麻醉诱导后切皮前静注乌司他丁30万U,对照组采用等量生理盐水。于麻醉诱导后切皮前,切皮后2h、4h,术后第1天、第2天、第3天采集动脉血,以流式细胞仪检测TLR4的表达变化,用ELISA试剂盒检测血浆TNF-α和IL-6浓度。结果:两组各时点CD14+单核细胞表面TLR4表达以及TNF-α、IL-6均较麻醉诱导后切皮前增加(P<0.05);乌司他丁组各指标值均较对照组上升幅度低(P<0.05)。结论:乌司他丁可有效抑制单核细胞表面TLR4的表达,抑制炎症因子的释放,对创伤失血性休克患者有一定的保护作用。

The Effects of Ulinastatin on Toll-like Receptor 4 in Monocyte of Patients with Trauma Bleeding Shock

Objective To investigate the effects ulinastatin on Toll-like receptor4 in monocyte of patients with trauma bleeding shock and the mechanism of ulinastatin to inhibit the inflammation reaction. Methods 60 patients with trauma bleeding shock were randomly divided into ulinastatin group （n=15）and control group （n=15） and received 12 000 UI/Kg ulinastatin and saline solution respectively after induction of anesthesia. The expression of monocyte surface TLR4 were analyzed by flow cytometry, and plasma level of TNF-α , IL-6 were measured by ELISA at following times：after induction of anesthesia （0 h）,beginning operation 2 h, beginning operation 4 h, post-operation 1 day, post-operation 2 days,post-operation 3 days.Rosults Both the expression of TLR4 in monocytes and the plasma concentration of TNF-α and IL-6 were upregulated after induction of anesthesia in two group （ P 〈 0.05）. The expressions TLR4 in monocytes and the plasma concentration of TNF-α and IL-6 in ulinastatin group were lower than in control group at different time point after induction of anesthesia （ P〈0.05）. Conclusion Ulinastatin can down-regulate the expression of TLR4 in monocytes and inhibit the release of inflammation factor to educe protective effect on trauma bleeding shock patients.