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目的观察扩张型心肌病(DCM)患儿外周血单核细胞Toll样受体4(Toll-like receptor4,TLR4)表达及与肿瘤坏死因子-α(TNF-α)浓度的相关性,探讨其与小儿DCM发生发展的关系。方法 2008年4月至2008年12月重庆医科大学附属儿童医院收治的DCM患儿18例,治疗前和治疗1年后分别应用流式细胞术检测外周血单核细胞TLR4的表达水平,ELISA法检测其血清TNF-α含量,心脏彩超检测其左室射血分数(LVEF)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室质量(LVmass),对照组为健康儿童17名。结果 DCM患儿治疗前外周血单核细胞TLR4平均荧光强度(MFI)及血清TNF-α浓度高于治疗1年后(P<0.05),且DCM患儿治疗前后均高于对照组(P<0.05)。TLR4表达与血清TNF-α水平呈正相关(P<0.05),且DCM患儿治疗前后TLR4、TNF-α水平的降低程度与LVEF、LVEDV、LVESV、LVmass改善程度相关。结论小儿DCM的TLR4上调,可能通过促使炎性因子分泌增多而损害心肌,介导小儿DCM的发生发展。
Objective To investigate the correlation between the expression of Toll-like receptor 4 (TLR4) and the concentration of tumor necrosis factor-α (TNF-α) in peripheral blood mononuclear cells of children with dilated cardiomyopathy (DCM) Relationship between pediatric DCM development and development. Methods 18 children with DCM admitted to Children’s Hospital of Chongqing Medical University from April 2008 to December 2008 were enrolled in this study. Flow cytometry was used to detect the expression of TLR4 in peripheral blood mononuclear cells before and 1 year after treatment. The content of TNF-α in serum was detected, the left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and left ventricular mass 17 children. Results The mean fluorescence intensity (MFI) and serum TNF-α levels of peripheral blood mononuclear cells in DCM children before treatment were significantly higher than those of 1 year after treatment (P <0.05), and those in DCM children were significantly higher than those in the control group before and after treatment (P < 0.05). There was a positive correlation between TLR4 expression and serum TNF-αlevel (P <0.05). The reduction of TLR4 and TNF-α in DCM children was correlated with the improvement of LVEF, LVEDV, LVESV and LVmass. Conclusion The up-regulation of TLR4 in pediatric DCM may damage the myocardium by increasing the secretion of inflammatory cytokines and mediate the occurrence and development of DCM in children.