Objective To investigate the expression of serum Toll-like receptors-4 (TLR4) and nuclear factor kappa B (NF-κB) in patients with exertional heat stroke (EHS) and their predictive value for patient prognosis.
Methods A total of 51 EHS patients who underwent treatment in 9th 00 Hospital from January 2017 to April 2019 were enrolled in the EHS group. According to the prognosis of the patients, they were divided into a poor prognosis group (11 cases) and a good prognosis group (40 cases). Another 51 healthy volunteers who were examined in our hospital during the same period were selected as the control group. Serum TLR4, NF-κB, tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and interleukin-6(IL-6) were detected by enzyme-linked immunosorbent assay. Patients′ Acute Physiology and Chronic Health Evaluation (APACHE-Ⅱ) scores were recorded.
Results The levels of serum TLR4, NF-κB, TNF-α, IL-1β, IL-6, and the APACHE-Ⅱ score in the EHS group were significantly higher than those in the control group ( P<0.05). The levels of serum TLR4, NF-κB, TNF-α, IL-1β, IL-6, and the APACHE-Ⅱscore in the poor prognosis group were significantly higher than those in the good prognosis group ( P<0.05). Serum TLR4 and NF-κB were positively correlated with TNF-α, IL-1β, IL-6 and APACHE-Ⅱscores in EHS patients ( P<0.05). ROC analysis showed that the area under the curve of TLR4 was 0.705 (95% CI: 0.547-0.862), the NF-κB was 0.691 (95% CI: 0.528-0.854), and the APACHE-Ⅱ score was 0.830 (95% CI: 0.706-0.953), combined detection of the three, can further improve the specificity and the Yoden index.
Conclusion Serum TLR4 and NF-κB are highly expressed in EHS patients, and their expression levels are positively correlated with inflammatory response and APACHE-Ⅱscore. APACHE-Ⅱ score combined with serum TLR4 and NF-κB can improve the predictive value of prognosis in patients with EHS.
摘要： 目的 探讨血清 Toll 样受体-4 (TLR4) 、核转录因子-κB (NF-κB) 在劳力性热射病 (EHS) 患者中的表达及其 对患者预后的预测价值。 方法 选取 2017 年 1 月—2019 年 4 月期间在联勤保障部队第九 00 医院接受治疗的 EHS 患者 51 例作为 EHS 组, 根据患者的预后情况分为预后不良组 (11 例) 、预后良好组 (40 例) 。另选取同期在我院体检的健康 志愿者 51 例作为对照组。采用酶联免疫吸附法检测血清中 TLR4、NF-κB、肿瘤坏死因子-α (TNF-α) 、白介素-1β (IL- 1β) 、白介素-6 (IL-6) 的水平, 记录患者的急性生理与慢性健康评分-Ⅱ (APACHE-Ⅱ) 评分。 结果 EHS 组患者的血 清 TLR4、NF-κB、TNF-α、IL-1β、IL-6 水平及 APACHE-Ⅱ评分高于对照组 ( P<0.05); 预后不良组患者的血清 TLR4、NF- κB、TNF-α、IL-1β、IL-6 水平及 APACHE-Ⅱ评分高于预后良好组 ( P<0.05); EHS 患者血清 TLR4、NF-κB 与 TNF-α、IL- 1β、IL-6、APACHE-Ⅱ评分均呈正相关 ( P<0.05); ROC 分析显示, TLR4 的曲线下面积为 0.705 (95% CI：0.547~0.862) , NF-κB 的曲线下面积为 0.691 (95% CI：0.528~0.854) , APACHE-Ⅱ评分的曲线下面积为 0.830 (95% CI：0.706~0.953) , 三 者联合检测, 可进一步提高特异度和约登指数。 结论 血清 TLR4、NF-κB 在 EHS 患者中异常高表达, 且其表达水平与 炎症反应、APACHE-Ⅱ评分呈正相关, APACHE-Ⅱ评分联合血清 TLR4、NF-κB 可提高对 EHS 患者预后的预测价值。