Toll样受体4信号通路对慢性心力衰竭患者心血管事件的预测  

Toll like receptor 4 signaling pathway for predicting cardiovascular events in patients with chronic heart failure

作　　者：文仙仙 张娜[1] 王兴兴 柳洁[1] WEN Xianxian;ZHANG Na;WANG Xingxing;LIU Jie(Department of Special Ward,Shanxi Provincial People's Hospital,Taiyuan 030012,China)

机构地区：[1]山西省人民医院特需病房,030012

出　　处：《心肺血管病杂志》2023年第6期547-552,共6页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探究外周血中toll样受体4(toll-like receptor,TLR4)/髓样分化因子(myeloid differentiation factor,MyD88)/核因子κB(nuclear factorκB,NF-κB)信号通路对慢性心力衰竭(chronic heart failure,CHF)患者心血管事件的预测价值。方法:选取2019年1月至2021年1月于山西省人民医院诊治的CHF患者124例,记为CHF组,按照病因分为冠心病组69例,扩张型心肌病(扩心病)组40例,高血压性心脏病(高心病)组15例,按照心功能分级,分为Ⅱ级组(n=40)、Ⅲ级组(n=50)和Ⅳ级组(n=34),根据是否存在不良心血管事件分为无不良心血管事件组(59例)、不良心血管事件组(65例),同期选取入院无明显心血管疾病、体检正常的健康者50例为对照组。比较各组患者外周血中TLR4、MyD88、NF-κB mRNA表达量,并绘制关于TLR4、MyD88、NF-κB mRNA的受试者工作特征曲线(ROC)以寻找其预测CHF患者发生心血管事件的最佳截断值。结果:CHF组LVEF、LVEDD以及外周血TLR4、MyD88、NF-κB mRNA表达显著高于对照组(P<0.05);三组在LVEF、LVEDD以及外周血TLR4、MyD88、NF-κB mRNA表达比较上,Ⅳ级组>Ⅲ级组>Ⅱ级组,两两比较差异均有统计学意义(P<0.05);Pearson分析发现,外周血TLR4、MyD88、NF-κB mRNA表达量与LVEF水平均呈负相关关系(P<0.05),而与LVEDD则呈正相关关系(P<0.05);不良心血管事件组患者外周血TLR4、MyD88、NF-κB mRNA表达显著高于无不良心血管事件组(P<0.05);ROC曲线分析显示,外周血TLR4、MyD88、NF-κB mRNA表达预测CHF患者发生不良心血管事件的AUC分别为0.753、0.651、0.664,当三者联合诊断时,其AUC、敏感度、特异度最高分别为0.893、84.60%、81.19%,均高于单独指标诊断价值(P<0.05)。结论:外周血中TLR4、MyD88、NF-κB mRNA表达在不同心功能分级CHF患者中存在差异,且与疾病严重程度密切相关,同时监测CHF患者上述标志物变化趋势对预测不良心血管事件发生具有一定临床意义。Objective:To explore the predictive value of toll-like receptor 4(TLR4)/myeloid differentiation factor(MyD88)/nuclear factorκB(NF-κB)signaling pathway in peripheral blood for cardiovascular events in patients with chronic heart failure(CHF).Methods:A total of 124 CHF patients who were diagnosed and treated in our Hospital from January 2019 to January 2021 were selected and recorded as CHF group.According to the etiology,they were divided into coronary heart disease group,69 cases,dilated cardiomyopathy(dilated cardiomyopathy)group,40 cases,hypertensive heart disease(high heart disease)group,15 cases.According to cardiac function classification,they were divided into grade II group(n=40)and grade III group(n=50)and grade IV group(n=34),according to the existence of adverse cardiovascular events,they were divided into a non-adverse cardiovascular event group(59 cases)and an adverse cardiovascular event group(65 cases).50 healthy subjects were the control group.The expression levels of TLR4,MyD88 and NF-κB mRNA in peripheral blood of patients in each group were compared,and the receiver operating characteristic curve(ROC)of TLR4,MyD88,and NF-κB mRNA was drawn to find the predictive value of cardiovascular events in CHF patients.best cutoff value.Results:The mRNA expressions of LVEF,LVEDD and peripheral blood TLR4,MyD88 and NF-κB in CHF group were significantly higher than those in control group(P<0.05);In the comparison of LVEF,LVEDD and peripheral blood TLR4,MyD88,NF-κB mRNA expression among the three groups,the grade IV group>the grade III group>the grade II group,the difference was statistically significant(P<0.05);Pearson analysis It was found that the expression of TLR4,MyD88 and NF-κB mRNA in peripheral blood was negatively correlated with LVEF level(P<0.05),but positively correlated with LVEDD(P<0.05).The peripheral blood TLR4,MyD88 and NF-κB mRNA expressions in the adverse cardiovascular event group were significantly higher than those in the non-adverse cardiovascular event group(P<0.05);ROC curve a

关 键 词：慢性心力衰竭 不良心血管事件 TLR4/MyD88/NF-κB信号通路 预测价值 

分 类 号：R54[医药卫生—心血管疾病]