慢性心力衰竭合并社区获得性肺炎患者血清TLR4表达及与PCT、NT-proBNP、氧化应激指标的相关性分析

Serum TLR4 expression and its correlation with PCT, NT proBNP and oxidative stress in patients with chronic heart failure with community acquired pneumonia

摘要:

目的 探讨慢性心力衰竭（CHF）合并社区获得性肺炎（CAP）患者血清Toll样受体4（TLR4）表达及其与降钙素原（PCT）、氨基末端B型利钠肽前体（NT-proBNP）、丙二醛（MDA）、超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-Px）的相关性。方法 选取2020年1月—2022年6月承德医学院附属医院收治的90例CHF患者为研究对象。根据入院时是否合并CAP将其分为合并CAP组42例和单纯CHF组48例。比较两组患者的一般资料及血清TLR4、PCT、NT-proBNP、MDA、SOD、GSH-Px水平，通过多因素Logistic逐步回归分析CHF患者合并CAP的影响因素，采用Pearson相关性分析血清TLR4与PCT、NT-proBNP、MDA、SOD、GSH-Px的相关性。结果 两组患者的性别、BMI、心功能分级、冠心病、吸烟史、饮酒史、白细胞计数及中性粒细胞计数比较，差异无统计学意义（P >0.05）。两组的年龄、CHF病程、COPD、高血压、糖尿病、侵入性操作、长期卧床、TLR4、PCT、NT-proBNP、MDA、SOD、GSH-Px比较，差异有统计学意义（P <0.05）。多因素Logistic逐步回归分析结果显示：年龄［O^R=1.255（95% CI：1.092，1.443）］、CHF病程［O^R=1.604（95% CI：1.202，2.141）］、糖尿病［O^R=7.453（95% CI：1.811，30.666）］、侵入性操作［O^R=20.668（95% CI：1.109，35.053）］、TLR4［O^R=1.048（95% CI：1.026，1.069）］、PCT［O^R=1.456（95% CI：1.071，1.979）］、NT-proBNP水平［O^R=1.001（95% CI：1.000，1.002）］是CHF患者合并CAP的危险因素（P <0.05）；GSH-Px ［O^R=0.905（95% CI：0.828，0.989）］是CHF患者合并CAP的保护因素（P <0.05）。Pearson相关性分析显示，血清TLR4表达与PCT、NT-proBNP、MDA呈正相关（r =0.335、0.265、0.356，均P <0.05），与GSH-Px呈负相关（r =-0.481，P <0.05），与SOD水平无相关性（r =-0.121，P >0.05）。结论 血清TLR4、PCT、NT-proBNP、GSH-Px水平是CHF患者合并CAP的独立影响因素，血清TLR4与PCT、NT-proBNP、MDA、GSH-Px表达水平相关。

Abstract:

Objective To explore the level of serum Toll like receptor 4 (TLR4) expression in patients with chronic heart failure (CHF) complicated with community acquired pneumonia (CAP) and its correlation with procalcitonin (PCT), N-terminal B-type natriuretic peptide precursor (NT proBNP), malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH Px).Method Ninety patients with CHF admitted to our hospital were selected as the research objects from January 2020 to June 2022. They were divided into CAP group (n = 42) and CHF group (n = 48) according to whether CAP was incorporated at admission. The general data and the levels of serum TLR4, PCT, NT-proBNP, MDA, SOD, GSH-Px were compared between the two groups. The risk factors of CHF patients with CAP were analyzed by univariate and multivariate logistic regression. Pearson correlation was used to analyze the correlation between serum TLR4 and PCT, NT-proBNP, MDA, SOD, GSH-Px.Results By univariate and multivariate logistic regression, age [O^R = 1.255 (95% CI: 1.092, 1.443) ], duration of CHF [O^R = 1.604 (95% CI: 1.202, 2.141) ], diabetes [O^R = 7.453 (95% CI: 1.811, 30.666) ], invasive operation [O^R = 20.668 (95% CI: 1.109, 35.053) ], TLR4 level [O^R = 1.048 (95% CI: 1.026, 1.069), PCT level [O^R = 1.456 (95% CI: 1.071, 1.979) ], and NT proBNP level [O^R = 1.001 (95% CI: 1.000, 1.002) ] were risk factors for CHF patients with CAP (P < 0.05); GSH Px level [O^R = 0.905 (95% CI: 0.828, 0.989) ] was the protective factor of CHF patients with CAP (P < 0.05). Pearson correlation analysis showed that serum TLR4 expression level was positively correlated with PCT level (r = 0.335, P = 0.001), NT proBNP level (r = 0.265, P = 0.012), and MDA level (r = 0.356, P = 0.001) (P < 0.05), negatively correlated with GSH Px (r = -0.481, P = 0.000), and had no significant correlation with SOD level (r = -0.121, P = 0.258).Conclusion Serum TLR4, PCT, NT-proBNP, and GSH-Px levels were independent influencing factors of CHF patients with CAP; Serum TLR4 was significantly correlated with the expression levels of PCT, NT-proBNP, MDA and GSH-Px.