外周血单个核细胞Toll样受体4/NOD样受体蛋白3信号通路在溃疡性结肠炎患者缓解期复发预测中的价值OA

Objective To investigate the value of the Toll-like receptor 4(TLR4)/NOD-like re-ceptor protein 3(NLRP3)signaling pathway in peripheral blood mononuclear cells in evaluating re-lapse during remission in patients with ulcerative colitis(UC).Methods A total of 182 patients with UC(development group)were selected and received standardized treatment.After achieving clinical remission,they were included in the study.Peripheral blood samples were collected from the patients 1 day after clinical remission,and the expression levels of molecules related to the TLR4/NLRP3 signaling pathway in peripheral blood mononuclear cells were detected as baseline indicators.Patients were followed up regularly for 12 months and divided into non-relapse group and relapse group ac-cording to their relapse status.General information and the levels of TLR4 and NLRP3 in peripheral blood mononuclear cells were compared between the two groups.Logistic regression analysis was used to screen for factors influencing UC relapse.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of peripheral blood TLR4 and NLRP3 for UC relapse.Ad-ditionally,based on the age and gender of the above 182 UC patients,and taking into account fac-tors such as disease severity,lesion extent,previous treatment history,disease duration,comorbidi-ties,laboratory indicators during remission,and smoking/alcohol consumption history,93 patients with comparable indicators to the development group were selected as the external validation group.Results There were significant differences in the Mayo score,intestinal wall thickness,depth of infiltration,extraintestinal manifestations,fecal lactoferrin,fecal calprotectin,erythrocyte sedimen-tation rate,procalcitonin and C-reactive protein between the two groups(P＜0.05).The levels of TLR4 and NLRP3 in the relapse group were higher than those in the non-relapse group,with a sta-tistically significant difference(P＜0.05).Logistic regression analysis showed that both TLR4 and NLRP3 were independently associated with relapse in UC patients(P＜0.05).The area under the curve(AUC)for the combined prediction of UC relapse by TLR4 and NLRP3 was 0.867,which was significantly higher than the AUCs for their individual predictions(P＜0.05).In the external validation,the AUC for the combined prediction by TLR4 and NLRP3 was 0.856,with no significant difference compared to the AUC for the internal combined prediction(P＞0.05).Conclusion High expression of TLR4 and NLRP3 in patients with UC during remission is an independent influencing factor for their relapse.Combined detection has a higher predictive value and can provide a refer-ence for prognostic risk stratification.Its clinical guiding significance requires further confirmation by prospective studies.