生大黄对急性胰腺炎TLR4受体表达的影响及临床意义

摘要

目的 探讨生大黄对急性胰腺炎(AP)患者TLR4受体表达的影响及临床意义.方法 纳入2010年1月-2011年12月在我院诊治的64例AP患者,其中48例为轻型急性胰腺炎(MAP),16例为重症急性胰腺炎(SAP).随机分成2组:常规治疗组和生大黄治疗组.收集其临床资料并留取治疗前后外周血各4 ml,提取单个核细胞,半定量PCR检测其TLR4的表达.收集20例健康体检者外周血作为对照.结果 (1)对照组外周血TLR4仅少量表达,AP患者治疗前外周血TLR4的表达量较对照组明显增高,SAP的TLR4表达明显高于MAP(P ＜0.05).(2)生大黄治疗组MAP/SAP的平均症状改善时间(9.2±3.8)/(18.6±5.2)d,明显短于相应常规治疗组(13.6±4.6)/(24.8±6.5)d(P＜0.05).(3)MAP/SAP患者经治疗有效后TLR4表达明显下降,生大黄组MAP/SAP的TLR4的下降程度明显高于相应的常规治疗组(P＜0.05).结论 TLR4受体的表达程度可用于评估AP的严重程度,生大黄治疗AP的机制可能与下调TLR4的表达有关.%Objective To explore the influence of rude rhubarb on the TLR4 expression in acute pancreatitis (AP) and its clinical significance. Methods 64 patients with AP including 48 cases of MAP and 16 cases of SAP treated from Jan. 2010 to Dec. 2011 were randomly divided into two groups: the conventional treatment group and rude rhubarb treatment group. The mononuclear cells were extracted from the peripheral blood of all the patients pre- and after treatment. The TLR4 expression was detected by RT-PCR and the influence of rude rhubarb on the TLR4 expression was explored. 20 cases of healthy examination people were enrolled as control group. Results ( 1 ) There was little TLR4 expression in control group. And the TLR4 expression was obviously elevated in acute pancreatitis, especially in SAP (P <0.05). (2) The MAP/SAP median time of symptom alleviation in rude rhubarb was(9.2±3.8)/(18.6±5.2) d, which was much shorter than that in conventional treatment group (13.6±4.6)/(24.8±6.5) d ( P < 0. 05 ) . (3) The MAP/SAP TLR4 expression in rude rhubarb treatment group treated effectively was obviously decreased compared with the MAP/SAP conventional treatment group (P <0. 05). Conclusion The TLR4 expression is helpful for the evaluation of the severity of AP, and the mechanism of rude rhubarb effectively treating AP might be associated with down-regulating TLR4 expression.