肝移植术病人围术期中性粒细胞Toll样受体2表达与术后SIRS的关系

目的 研究肝移植术病人围术期中性粒细胞Toll样受体2(TLR2)表达与术后全身炎性反应综合征(SIRS)的关系.方法 择期行肝移植术的终末期肝病病人20例,年龄33～58岁,体重52～73 kg,心功能Ⅱ或Ⅲ级,ASAⅢ或Ⅳ级.于麻醉诱导前(T1)、无肝期25 min(T2)、新肝期3 h(T3)、新肝期24 h(T4)时,中心静脉采血样,采用流式细胞仪测定中性粒细胞TLR2表达;ELISA法测定血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)和白细胞介素-8(IL-8)浓度;按术后7 d内是否发生SIRS,分为SIRS组与非SIRS组.2组TNF-α、IL-1β和IL-8浓度和TLR2表达进行Spearman相关分析.结果 术后7 d内有10例病人发生SIRS.与T1时比较,SIRS组T4时中性粒细胞TLR2表达上调,T2-4时TNF-α浓度升高,T3,4时IL-1β浓度升高,T3时IL-8浓度升高(P＜0.05或0.01);与NSIRS组比较,SIRS组T4时中性粒细胞表达上调,血清IL-1β浓度升高,T3时血清IL-8浓度升高(P＜0.05或0.01).SIRS组TNF-α浓度与中性粒细胞TLR2表达呈正相关(r=0.607,P＜0.05).结论 肝移植术后病人发生SIRS可能与新肝期24 h中性粒细胞TLR2表达上调有关.

Relationship between Toll-like receptor 2 on polymorphonuclear neutrophil and postoperative systemic inflammatory response syndrome in pafients undergoing orthotopic liver transplantation

Objective To investigate the role of Toll-like receptor 2(TLR2)on polymorphonuclear neutrophil(PMN)during perioperative period in the development of postoperative systemic inflammatory response syndrome(SIRS)in patients undergoing orthotopic liver transplantation(OLT).Methods Twenty ASA Ⅲ or Ⅳ patients(NYHA Ⅱ or Ⅲ)of both sexes(18 male,2 female)aged 33-58 yr weighing 52-73 kg undergoing OLT were studied.Blood samples were collected from central vein for determination of TLR2 expression on PMN and plasma TNF-α,IL-1β and IL-8 concentrations before induction of anesthesia(T1,baseline),at 25 min of anhepatic phase(T2),3 h(T3)and 24 h after beginning of reperfusion of the allograft(T4).The expression of TLR2 was measured by flow cytometry and the serum concentrations of TNF-α,IL-β and IL-8 were measured by enzyme linked immuno-sorbant assay(ELISA).The patients were divided into SIRS and non-SIRS group depending on whether the patients developed SIPS or not within 7 days after operation. The diagnosis of SIRS was based on the criteria laid down by ACCP and SCCM in 1992.Results Ten patients developed SIRS within 7 days after operation.There was no significant difference in Child-Turcotte-Pugh(CTP)scores between the 2 groups.Compared with non-SIRS group,the TLR2 expression on PMN and the~rllm IL-1β concentration were significantly increased at T4,and the serum IL-8 concentration were significantly increased at T3 in SIRS group.There was positive correlation between serum TNF-α concentration and TLR2 expression on PMN in SIRS group(r=0.607,P＜0.05).Conclusion The expression of TLB2 on PMN increases significantly at 24 h after beginning of reperfusion of allograft and may play an important role in the development of postoperative SIRS.