细胞焦亡与慢性心力衰竭患者的相关性研究

Study on the correlation between pyroptosis and patients with chronic heart failure

目的:通过检测慢性心力衰竭患者血清中核苷酸结合寡聚化结构域样受体3(NLRP3)和半胱氨酸天冬酶-1(Caspase-1)以及白细胞介素-1β(IL-1β)水平,研究细胞焦亡在心力衰竭过程中的变化规律及其意义。方法:选择在本院确诊的慢性心力衰竭患者180例(慢性心力衰竭组)以及健康体检者40例(正常对照组),依据纽约心脏协会(NYHA)的分级标准,其中Ⅱ级48例、Ⅲ级60例、Ⅳ级72例。入院后完善N末端脑钠肽前体(NT-proBNP)以及左心室舒张末期内径(LVEDD)、左室舒张末期容积(LVEDV)、左心室射血分数(LVEF)的超声形态学检查。通过ELISA检测所有样本血清中NLRP3、Caspase-1和IL-1β的表达水平,统计分析慢性心力衰竭患者不同分级NLRP3、Caspase-1、IL-1β和相关指标的联系,研究细胞焦亡与慢性心力衰竭发生发展中的关系。结果:慢性心力衰竭组NLRP3、Caspase-1、IL-1β、NT-proBNP和LVEDD、LVEDV高于正常对照组,LVEF低于正常对照组,差异有统计学意义(P<0.05)。NLRP3、Caspase-1、IL-1β、NT-proBNP和LVEDD、LVEDV水平随着患者心功能分级逐级增高,而LVEF水平随着患者心功能分级逐级降低(P<0.05)。Pearson分析显示:NLRP3、Caspase-1、IL-1β与NT-proBNP、LVEDD、LVEDV呈正相关(r=0.398、0.396、0.398、0.506、0.499、0.505、0.449、0.422、0.424,P<0.01),与LVEF呈负相关(r=-0.400、-0.555、-0.438,P<0.01)。NLRP3、Caspase-1和IL-1β诊断心力衰竭受试者工作特征曲线(ROC曲线)下面积分别为0.768、0.805和0.799,差异具有统计学意义(P<0.01)。结论:慢性心力衰竭患者血清中的NLRP3、Caspase-1和IL-1β水平高于正常对照组,而且随心功能的恶化逐渐升高。细胞焦亡对慢性心力衰竭的发生发展有一定的指导意义。

Objective To study the changes of pyroptosis in heart failure and its significance.MethodsTotally 180 patients with chronic heart failure(the chronic heart failure group)and 40 healthy patients(the normal control group)diagnosed in our hospital from February 2018 to October 2019 were selected.According to the New York Heart Association(NYHA)classification standard,among the 180 patients there were 48 cases ofⅡlevel,60 cases ofⅢlevel and 72 patients ofⅣlevel.After admission,the N-terminal brain natriuretic peptide precursor(NT-proBNP),the left ventricular end-diastolic diameter(LVEDD),the left ventricular end-diastolic volume(LVEDV)and the left ventricular ejection fraction(LVEF)were examined by ultrasonic morphological examination.The expression levels of NLRP3,caspase-1 and IL-1βin serum of all samples were detected by ELISA,and the association of NLRP3,caspase-1,IL-1βand related indicators in patients with chronic heart failure of different grades was statistically analyzed,so as to investigate the relationship between pyroptosis and the occurrence and development of chronic heart failure.Results The levels of NLRP3,caspase-1,IL-1β,NT-proBNP,LVEDD and LVEDV in the chronic heart failure group were higher than those in the normal control group and LVEF in the chronic heart failure group was lower than that in normal control group,with statistically significant differences(P<0.05).Levels of NLRP3,caspase-1,IL-1β,NT-proBNP,LVEDD and LVEDV increased with patients'cardiac function grading,while LVEF decreased with patients'cardiac function grading(P<0.05).Pearson analysis showed that NLRP3,caspase-1 and IL-1βwere positively correlated with NT-proBNP,LVEDD and LVEDV(r=0.398,r=0.396,r=0.398,r=0.506,r=0.499,r=0.505,r=0.449,r=0.422,r=0.424;P<0.01)and negatively correlated with LVEF(r=-0.400,r=-0.555,r=-0.438;P<0.01).The area under the ROC curve of NLRP3,caspase-1 and IL-1βfor diagnosing heart failure was 0.768,0.805 and 0.799,respectively,with statistically significant differences(P<0.01).Conclusion Serum levels of NLRP3,caspase-1 and IL-1βwere higher in patients with chronic heart failure than in the controls and continued to increase as the heart function deteriorated.Pyroptosis has a certain guiding significance for the occurrence and development of chronic heart failure.