血清TLR4、MyD88在尿毒症合并心力衰竭患者诊断中的应用价值  

The value of serum TLR4 and MyD88 in the diagnosis of uremia combined with heart failure

作　　者：苏晓琳[1] 邝日禹[1] 覃凯[1] 雷玲艳 李依阳[1] 黄振华[1] 黄蔚 SU Xiaolin;KUANG Riyu;QIN Kai(Department of Cardiology,Guangxi Zhuang Autonomous Region Nationalities Hospital,Guangxi,Nanning 530001,China)

机构地区：[1]广西壮族自治区民族医院心内科,南宁市530001

出　　处：《河北医药》2023年第24期3736-3740,共5页Hebei Medical Journal

基　　金：广西壮族自治区科技计划项目(编号:2020JJB140178)。

摘　　要：目的观察Toll样受体4(TLR4)、髓样分化因子88(MyD88)在尿毒症合并心力衰竭(心衰)患者诊断中的临床价值。方法选取2019年2月至2021年2月收治的160例尿毒症患者为研究对象,根据是否发生心衰分为单纯尿毒症组(n=96)和尿毒症合并心衰组(n=64)。酶联免疫吸附实验检测血清TLR4,MyD88水平。比较2组血清TLR4,MyD88水平及心功能指标[心排出量(CO)、心脏指数(CI)、左心室射血分数(LVEF)]。Pearson相关分析血清TLR4,MyD88水平与心功能指标的相关性。多因素Logistic回归分析影响尿毒症合并心衰的因素。受试者工作特征曲线评估血清TLR4,MyD88水平对尿毒症合并心衰的诊断价值。结果尿毒症合并心衰组患者血清TLR4[(5.66±0.63)μg/L vs.(3.91±0.56)μg/L],MyD88[(2.79±0.46)vs.(1.01±0.31)]高于单纯尿毒症组,而CO,CI,LVEF低于单纯尿毒症组,差异均有统计学意义(t=7.364~29.255,均P<0.05)。NYHA心功能分级Ⅳ级患者血清TLR4,MyD88水平高于Ⅱ级、Ⅲ级患者,差异均有统计学意义(t=7.175~23.020,P<0.05)。血清TLR4,MyD88水平与CO,CI,LVEF呈显著负相关(r=-0.521~-0.705,均P<0.05)。血清TLR4(OR=1.451,95%CI=1.120~1.879),MyD88(OR=1.442,95%CI=1.096~1.897)升高是影响尿毒症合并心衰发生的独立危险因素。血清TLR4,MyD88联合对尿毒症合并心衰诊断的曲线下面积为0.892(0.858~0.948),高于TLR4,MyD88单一检测0.783(0.734~0.829),0.816(0.760~0.847),联合检测的敏感度为0.872,特异度为0.755。结论尿毒症合并心衰患者血清TLR4,MyD88水平升高,两者与心功能状态有关,血清TLR4,MyD88联合检测对尿毒症合并心衰的具有较高的评估价值。Objective To observe the clinical value of Toll-like receptor 4(TLR4)and myeloid differentiation factor 88(MyD88)in the diagnosis of uremia combined with heart failure.Methods A total of 160 uremia patients from February 2019 to February 2021 were selected as the study subjects.They were divided into uremia group(n=96)and uremia complicated with heart failure group(n=64)according to the presence of heart failure or not.Serum levels of TLR4 and MyD88 were detected by enzyme-linked immunosorbent assay.Serum TLR4 and MyD88 levels and cardiac function indexes,including cardiac output(CO),cardiac index(CI),and left ventricular ejection fraction(LVEF)were compared between the two groups.The correlation of serum TLR4 and MyD88 with cardiac function indexes was analyzed by Pearson correlation analysis.Multivariate logistic regression analysis was used to analyze the factors affecting uremia complicated with heart failure.The diagnostic value of serum TLR4 and MyD88 levels in uremia combined with heart failure was evaluated by the receiver operating characteristic(ROC)curves.Results Serum TLR4[(5.66±0.63)μg/L vs(3.91±0.56)μg/L]and MyD88[(2.79±0.46)vs(1.01±0.31)]in patients of uremia complicated with heart failure group were significantly higher than those of the uremia group,while CO,CI and LVEF were significantly lower(t=7.364-29.255,all P<0.05).Serum TLR4 and MyD88 levels in patients with the New York Heart Association(NYHA)Functional Classification of grade IV were significantly higher than those in patients with NYHA gradeⅡandⅢ(t=7.175-23.020,P<0.05).Serum TLR4 and MyD88 levels were significantly negatively correlated with CO,CI and LVEF(r=-0.521~0.705,all P<0.05).Increased serum TLR4(OR=1.451,95%CI:1.120-1.879),MyD88(OR=1.442,95%CI:1.096-1.897)were independent risk factors affecting the occurrence of uremia complicated with heart failure.The area under the curve(AUC)of the combined diagnosis of serum TLR4 and MyD88 was 0.892(0.858-0.948),which was significantly larger than that of a single detection of TLR4

关 键 词：尿毒症 心力衰竭 TOLL样受体4 髓样分化因子88 诊断 

分 类 号：R692.5[医药卫生—泌尿科学]