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

背景：前瞻性研究嘌呤能受体在大手术后危重症发病中的作用。方法：采用逆转录聚合酶链反应法检测49例连续行肝胆胰大手术患者围手术期外周血单个核细胞P2X7、A2A、T-bet和GATA-3 mRNA的表达水平。结果：不良组患者术前及术后早期P2X7 mRNA表达及P2X7/A2A比值均显著降低（p < 0.05）。不良组术后T-bet/GATA-3比值明显降低（p < 0.05）。T-bet/GATA-3比值与POD 0和1上P2X7 mRNA表达和P2X7/A2A比值极显著相关（p < 0.01）。POD 0上P2X7 mRNA表达与并发症严重程度呈负相关（p < 0.05）。结论：这些结果提示P2X7和A2A可能在术后危重症的发病机制中起关键作用。

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.