The expression of toll receptor-4 in patients with multiple organ dysfunction syndrome induced by acute cerebral vascular disease / 中华急诊医学杂志

ABSTRACT

Objective To study the expression of toll rexeptor-4 in patients with systemic infanunatory response syndrome(SIRS)and multiple organ dysfunction syndrome (MODS) induced by acute cerebral vascular disease(ACVD).Method Totally 153 ACVD patients,admitted to Departments of Neurology Medicine and ICU of the First,the Second and the Forth Hospitals of Jilin University from October 2005 to March 2006,were enrolled in this study.The patients were admitted to the hospitals within 3 days after onset,and were confirmed by CT or MRI.The 153 patients in the prospective study was divided into three groupaACVD group(n=60).SIRS group induced by ACVD(n=45),MODS group induced by ACVD(n=48).The diagnosis criteria accorded with the criterion set by the Forth Conference of Cerebrovuscular Disease in China.The exclusion criterion inchided①patients with infeetion or inflammatory disease two weeks before the onset of AVCD;②patients with cardiac disease,including acute myocarditis,acute myocardial infarction,angina episodes,degenerative calcific valvular disease,and so on;③patients with use of hormone recently;④malignant tumor,autoimmunity system disease,liver disease,kidney disease and hematologic disease.The expression of TLR-4 mRNA gene of the nucleated cell in the peripheral blood in the ACVD patient was measured by using RT-PCR.Statistics methods of t test,q test and simplex factor analysis of variance have been used Statistical analysis was carried out by using T-test,one-way analysis of variances,and q-test.Results The expression of TLR-4mRNA obviously increased on the third day after onset of AVCD.Compared with ACVD group,the expression of TLR-4mRNA in SIRS group was significantly higher (0.61±0.13 vs.0.98±0.15,P＜0.01).Compared with SIRS group,the expression of TLR-4mRNA in MODS group was significantly higher(0.98±0.15 vs.1.32±0.38,P＜0.01).The expression of TLR-4mRNA had a increasing tendency with the severity of AVCD.The expression of TLR-4mRNA was higher in patients with higher MODS score(P＜0.01).In the MODS group,the expression of TLR-4 mRNA was higher in the fatal patients than that in the survivors(1.56±0.16 vs.1.32±0.26,P＜0.01).Conclusions The mechanism of ACVD.which causes SIRS and MODS,may be associated with excessive immunologic respun of the organism.