摘要
目的 探讨脓毒症合并心肌损伤患者Toll样受体4(TLR4)/核因子-κB(NF-κB)信号通路与心肌损伤标志物的相关性.方法 回顾性选取2020年6月至2022年6月应急管理部应急总医院收治的脓毒症患者84例作为研究对象,根据患者有无心肌损伤分为无心肌损伤组(n=59)和心肌损伤组(n=25).以酶联免疫吸附试验法检测血清脑钠肽(BNP)、N末端B型脑钠肽(NT-proBNP)、人心型脂肪酸结合蛋白(h-FABP)、心肌肌钙蛋白Ⅰ(cTnⅠ)、肌酸激酶同工酶(CK-MB);以实时荧光定量PCR法检测外周血单个核细胞(PBMC)中TLR4、NF-KB、MyD88 mRNA相对表达量.比较两组血清 BNP、NT-proBNP、h-FABP、cTn Ⅰ、CK-MB 水平,以及 PBMC 中 TLR4、NF-KB、MyD88 mR-NA 相对表达量.以Pearson相关系数分析血清BNP、NT-proBNP、h-FABP、cTn Ⅰ、CK-MB水平与TLR4、NF-κB、MyD88相对表达量的相关性.结果 心肌损伤组血清BNP、NT-proBNP、h-FABP、cTnⅠ、CK-MB水平分别为(442.17 ±85.06)ng/L、(2 306.94±417.39)pg/mL、(16.09±3.17)µg/L、(0.43±0.11)μg/L、(11.47±3.75)μg/mL,均高于无心肌损伤组[(374.39±51.82)ng/L、(418.52±112.64)pg/mL、(13.27±3.84)μg/L、(0.24±0.07)µg/L、(2.16± 0.41)µg/mL],差异均有统计学意义(P＜0.05).心肌损伤组TLR4、NF-KB、MyD88 mRNA相对表达量分别为2.73± 0.42、2.33±0.38、1.94±0.47,均高于无心肌损伤组(1.68±0.35、1.49±0.24、1.22±0.29),差异均有统计学意义(P＜0.05).经相关性分析,血清 BNP、NT-proBNP、h-FABP、cTn Ⅰ、CK-MB 水平与 TLR4、NF-κB、MyD88 mRNA 相对表达量呈正相关(P＜0.05).结论 脓毒症合并心肌损伤患者血清BNP、NT-proBNP、h-FABP、cTn Ⅰ、CK-MB等标志物水平出现明显升高,其机制可能与TLR4/NF-κB信号通路的激活有关.
Abstract
Objective To investigate the correlation between Toll-like receptor 4(TLR4)/nuclear factor-κB(NF-κB)signaling pathway and markers of myocardial injury in patients with sepsis complicated with myocardial injury.Methods A total of 84 patients with sepsis admitted to Emergency General Hospital of Emergency Management from June 2020 to June 2022 were retrospectively selected as the study sub-jects,and they were divided into no myocardial injury group(n=59)and myocardial injury group(n=25)according to whether the patients had myocardial injury or not.Serum brain natriuretic peptide(BNP),N-terminal B-type brain natriuretic peptide(NT-proBNP),human fat-ty acid binding protein(h-FABP),cardiac troponin Ⅰ(cTn Ⅰ)and creatine kinase isoenzyme(CK-MB)were detected by enzyme-linked immunosorbent assay.The relative expression levels of TLR4,NF-κB and MyD88 mRNA of peripheral blood mononuclear cell were detected by real time fluorogenic quantitative PCR.The levels of serum BNP,NT proBNP,h-FABP,cTn Ⅰ,CK-MB,as well as TLR4,NF-κB,MyD88 in PBMC of two groups were compared.The relative expression levels of MyD88 mRNA were compared.The correlation between the levels of BNP,NT-proBNP,h-FABP,cTn Ⅰ and CK-MB and the relative expression levels of TLR4,NF-κB and MyD88 in serum was analyzed by Pearson correlation coefficient.Results The levels of serum BNP,NT-proBNP,h-FABP,cTnⅠ and CK-MB in myocardial injury group were(442.17 ±85.06)ng/L,(2 306.94±417.39)pg/mL,(16.09±3.17)μg/L,(0.43±0.11)μg/L,and(11.47±3.75)μg/mL,respectively,which were higher than those in the no myocardial injury group[(374.39±51.82)ng/L,(418.52±112.64)pg/mL,(13.27±3.84)μg/L,(0.24±0.07)μg/L,(2.16±0.41)μg/mL],the differences were statistically significant(P＜0.05).the relative expressions of TLR4,NF-κB and MyD88 mRNA in myocardium injury group were 2.73±0.42,2.33±0.38 and 1.94±0.47,respectively,which were higher than those in the no myocardial injury group(1.68±0.35,1.49±0.24 and 1.22±0.29),the differences were statistically significant(P＜0.05).Correlation analysis showed that the levels of serum BNP,NT-proBNP,h-FABP,cTn Ⅰ and CK-MB were positively correlated with the rela-tive expression levels of TLR4,NF-κB and MyD88 mRNA(P＜0.05).Conclusion Serum levels of BNP,NT-proBNP,h-FABP,cTnⅠ,CK-MB were significantly increased in patients with sepsis complicated with myocardial injury,the mechanism of which may be related to the activation of TLR4/NF-κB signaling pathway.
基金项目
中国应急管理部应急医学科研项目(KY202305)
维普
万方数据