乌司他丁对重症急性胰腺炎患者早期外周血单核细胞Toll样受体4表达的影响

目的:研究乌司他丁对重症急性胰腺炎患者早期外周血单核细胞Toll-样受体4(TLR4)表达的影响.方法:将58例重症急性胰腺炎患者随机分为乌司他丁组(29例,予以常规治疗+乌司他丁)和常规组(29例,予以常规治疗),同时选择20例健康志愿者作为对照组.入院后第1、3、5、7、14天采集静脉血,对照组仅采血1次.用流式细胞仪检测外周血单核细胞TLR4、CD14的表达,用ELISA试剂盒检测血浆TNF-α、IL-6的浓度,并分析与TLR4表达的相关性.结果:与对照组比较,在入院第1天常规组和乌司他丁组患者外周血单核细胞TLR4表达明显增高(P＜0.01),两组在入院后第3、5天TLR4表达逐渐降低,但仍高于对照组(P＜0.05).乌司他丁组与常规组相比,入院第1天治疗前,外周血单核细胞TLR4表达差异无统计学意义(P＞0.05),而在入院后第3、5、7天乌司他丁组外周血单核细胞TLR4的表达均明显低于常规组(P＜0.05).血浆TNF-a、IL-6浓度的变化与TLR4变化一致.结论:重症急性胰腺炎患者早期外周血单核细胞表面TLR4的表达明显增高,乌司他丁对重症急性胰腺炎引起的全身炎症反应的拮抗和抑制作用与其抑制单核细胞表面Toll样受体4的表达从而抑制炎症反应有关.

Effect of ulinastatin on toll-like receptor 4 expression of peripheral blood monocytes in patients with severe acute pancreatitis

Objective: To investigate the effect of ulinastatin on toll-like receptor 4(TLR4) expression of peripheral blood monocytes in patients with severe acute pancreatitis(SAP).Methods: Fifty-eight patients with SAP were randomly divided into ulinastatin group(n=29) and routine group(n=29).Healthy volunteers were included as control group(n=20).Blood samples were collected by venipuncture on the day of admission and 3,5,7,14 day after admission.TLR4 and CD14 expressions on peripheral blood monocytes(PBMCs) were detected by flow cytometry.Plasma level of serum tumor necrosis factor alpha(TNF-α) and interleukin 6(IL-6) were measured by ELISA simutaneously.Correlations between these parameters were analyzed.Results: The expression of TLR4 was obviously up-regulated in ulinastatin group and routine group than that in control group on the day of admission(P<0.01).On the day of 3,5 after admission,the expressions of TLR4 were continued to decline,but still were higher than those of control group(P<0.05).The expression of TLR4 in ulinastatin group was lower than that of routine group on the day of 3,5,7 after admission(P<0.05).The alteration of TNF-α and IL-6 were consistent with that of TLR4.Conclusions: The expression of TLR4 in PBMCs is up-regulated in patients with SAP.Ulinastatin can down-regulate the expression of TLR4 in PBMCs and inhibit the inflammation reaction to educe protective effect on patients with SAP.