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目的探讨脓毒症患者血小板Toll样受体4(TLR4)表达变化与血小板活化的关系及对预后的影响。方法选取本院ICU 2012年8月至2014年8月收治的72例脓毒症患者为病例组,另选取同期门诊健康体检对象50例为健康组,比较病例组患者入院时与入院后不同时间点血小板参数、血小板表面TLR4、血小板膜糖蛋白Ⅱb/Ⅲa纤维蛋白原受体(PAC-1)阳性表达率的差异。根据预后情况将病例组患者分为死亡组和存活组,并比较两组患者相关指标差异。结果病例组患者入院时、入院后3天和7天血小板计数(PC)均显著低于健康组(P<0.05)。病例组患者入院时平均血小板体积(MPV)、血小板分布宽度(PDW)、TLR4、PAC-1阳性表达率均显著高于健康组(P<0.05),入院后3天PDW、TLR4、PAC-1阳性表达率均显著高于健康组(P<0.05),入院后7天TLR4、PAC-1阳性表达率均显著高于健康组(P<0.05)。病例组患者自治疗至出院,死亡27例(37.5%)。存活组患者入院时、治疗7天后TLR4、PAC-1阳性表达率、降钙素原(PCT)水平、急性生理功能与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、感染相关器官功能衰竭评分系统(SOFA)评分均显著低于死亡组(P<0.05)。TLR4预测脓毒症患者不良预后的ROC曲线下面积(AUC)=0.816,PAC-1的AUC=0.782,PCT的AUC=0.844,预测能力依次为PCT>TLR4>PAC-1。结论脓毒症患者TLR4表达上调伴随血小板活化,TLR4阳性表达率升高可作为脓毒症患者预后评估的一项辅助指标。
Objective To investigate the relationship between the changes of platelet Toll-like Receptor 4 (TLR4) expression and platelet activation in patients with sepsis and its prognosis. Methods Seventy-two sepsis patients admitted to ICU from August 2012 to August 2014 in our hospital were selected as case group. Another 50 healthy subjects were selected as health group during the same period. Patients in comparison group were admitted to hospital at different times after admission Point platelet parameters, platelet surface TLR4, platelet membrane glycoprotein Ⅱ b / Ⅲ a fibrinogen receptor (PAC-1) positive expression rate differences. Patients in the case group were divided into death group and survival group according to the prognosis, and the differences between the two groups were compared. Results In the case group, the platelet count (PC) at 3 days and 7 days after admission was significantly lower than that in the healthy group (P <0.05). The mean platelet volume (MPV), platelet distribution width (PDW), TLR4 and PAC-1 positive rate in case group were significantly higher than those in healthy group (P <0.05), and PDW, TLR4 and PAC-1 (P <0.05). The positive rates of TLR4 and PAC-1 on the 7th day after admission were significantly higher than those in the healthy group (P <0.05). In the case group, 27 patients (37.5%) were self-treated and discharged from hospital. At 7 days after treatment, the survival rate of TLR4, PAC-1, PCT, APACHEⅡ, TNF-alpha SOFA) scores were significantly lower than the death group (P <0.05). The area under the ROC curve (AUC) of TLR4 predicting the adverse prognosis of patients with sepsis was 0.816, the AUC of PAC-1 was 0.782, and the AUC of PCT was 0.844. The predictive ability of TLR4 was PCT> TLR4> PAC-1. Conclusion The up-regulation of TLR4 expression in septic patients is accompanied by the activation of platelet. The increased expression of TLR4 may be used as an adjunct to prognosis evaluation of sepsis patients.