Perioperative expression of pattern-recognition receptors in peripheral blood mononuclear cells from patients undergoing hepatobiliary pancreatic surgery

背景：嘌呤能受体在大手术后危重病发病机制中的作用进行了前瞻性研究。研究方法：采用逆转录-聚合酶链反应（RT-PCR）检测49例肝胆胰大手术患者围手术期外周血单个核细胞P2 X7、A2 A、T-bet和加塔-3 mRNA的表达水平。结果如下：P2 X7 mRNA表达和P2 X7/A2 A比值在不良组术前和术后早期均显著低于对照组（p < 0.05）。不良组术后T-bet/加塔-3比值明显低于对照组（p < 0.05）。T-bet/加塔-3比值与P2 X7 mRNA表达和P2 X7/A2 A比值在POD 0和POD 1均呈显著正相关（p < 0.01）。P2 X7 mRNA表达与术后并发症严重程度呈负相关（p < 0.05）。结论：P2 X7和A2 A可能在术后危重病的发病中起重要作用。

Background: The role of purinergic receptors in pathogenesis of postoperative critical illness following major surgery was prospectively investigated. Methods: Expression levels of P2X7, A2A, T-bet, and GATA-3 mRNA in peripheral blood mononuclear cells were assayed by reverse transcription-polymerase chain reaction perioperatively in 49 consecutive patients who underwent major hepatobiliary pancreatic surgery. Results: P2X7 mRNA expression and P2X7/A2A ratio were significantly lower in unfavorable group (p < 0.05) in preoperative or early postoperative period. Postoperative T-bet/GATA-3 ratio was significantly lower in unfavorable group (p < 0.05). T-bet/GATA-3 ratio correlated significantly with P2X7 mRNA expression and P2X7/A2A ratio on POD 0 and 1 (p < 0.01). P2X7 mRNA expression on POD 0 negatively correlated with severity of complications (p < 0.05). Conclusions: These results suggest that P2X7 and A2A may play a pivotal role in pathogenesis of postoperative critical illness.