肝移植围术期单核细胞TLR24高表达与术后急性肺损伤的关系1.doc

肝移植围术期单核细胞TLR2/4高表达与术后急性肺损伤的关系1 中山大学附属第三医院麻醉科（广州，510630） 池信锦 蔡 珺 程 楠 黑子清2 黎尚荣 罗刚健 【摘要】 目的 研究肝移植围术期单核细胞TLR2/4表达及血清炎性因子浓度的变化与肝移植早期急性肺损伤的关系。方法 设计自身配对实验，采集32例肝移植患者麻醉后手术前、无肝25min、新肝3h、新肝24h时的中心静脉血，用流式细胞仪检测单核细胞TLR2/4的表达；ELISA法检测血清TNF-α、IL-1β和IL-8浓度；通过术后随访，分析肝移植围术期TLR2/4表达与急性肺损伤的关系。结果 单核细胞TLR2/4表达在新肝3h、新肝24h显著上调(P＜0.05)；围术期血清TNF-α、IL-1β和IL-8浓度也显著升高 (P＜0.01)，与TLR2/4的表达呈正相关(P＜0.05)；围术期TLR2/4高表达与急性肺损伤的关系密切，是术后发生急性肺损伤的高危因素。结论 肝移植围术期单核细胞TLR2/4高表达是术后发生急性肺损伤的高危因素。 [关键词] 原位肝移植；TLR2；TLR4；炎性因子；急性肺损伤 Relationship between the expression of toll like receptor 2 and 4 in mononuclear cells and postoperative acute lung injury during orthotopic liver transplantation CHI Xin-jin,CAI Jun,CHENG Nan,HEI Zi-qing,LI Shang-rong,LUO Gang-jian. [Abatract] Objective: To investigate the dynamic expression of Toll Like Receptor 2 and 4 (TLR2/4) in peripheral blood mononuclear cells and serum inflammatory factors, and the relationship between TLR2/4 expression and acute lung injury (ALI) in postoperative patients of orthotopic liver transplantation (OLT). Methods: 32 cases (25 men and 7 women with ASA III to IV) received OLT. Their peripheral blood were collected for measurement of TLR2/4. The expression of TLR2/4 in mononuclear cells was measured by flow cytometer. Serum concentrations of TNF-α, IL-1β and IL-8 were measured by enzyme-linked immuno-sorbentassay (ELISA). The relationship between the expression of TLR2/4 and postoperative ALI were also analyzed. Results: The expression of TLR2/4 in mononuclear cells increased significantly at 3h and 24h neohepatic. Serum concentrations of TNF-α,IL-1β and IL-8 were also increased significantly. There was a positive correlation between expression of TLR2/4 in mononuclear cells and the serum concentrations of TNF-α IL-1β IL-8. Statistical results showed that the high level of TLR2/4 expression in mononuclear cells could be a high risk factor of ALI in postoperative patients of OLT. Conclusion: The level of TLR2/4 expression in mononuclear cells