Hp感染对颈动脉粥样硬化患者TLR4/NF-κB信号通路和斑块易损性的影响

Influence of Hp infection on TLR4/NF-κB signaling pathways and plaques vulnerability of patients with carotid atherosclerosis

目的 探讨幽门螺杆菌(Hp)感染对颈动脉粥样硬化患者Toll样受体4(TLR4)/核因子-κB(NF-κB)信号通路和斑块易损性的影响。方法 选取丽水市人民医院2016年10月-2020年10月收治的Hp感染颈动脉粥样硬化患者169例为Hp感染组和无Hp感染颈动脉粥样硬化患者147例为无Hp感染组,根据颈动脉超声结果分为无斑块组94例、稳定斑块组88例和易损斑块组134例,流式细胞法检测外周血单个核细胞TLR4和NF-κB表达水平,分析临床资料和TLR4、NF-κB表达水平和斑块易损伤危险因素。结果 Hp感染组易损斑块占比、超敏C-反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、TLR4和NF-κB水平、动脉内膜中层厚度(IMT)、斑块Crouse积分(CPI)和斑块总面积(CPA)高于无Hp感染组(P<0.05)。稳定斑块组、易损伤斑块组TC、TG、hs-CRP、TNF-α、IL-6水平和TLR、NF-κB表达水平均高于无斑块组(P<0.05),IMT高于无斑块组(P<0.05);易损伤斑块组TC、TG、hs-CRP、TNF-α、IL-6水平和TLR、NF-κB表达水平高于稳定斑块组(P<0.05),糖尿病占比、高血压占比、Hp感染占比、IMT、CPI和CPA高于稳定斑块组(P<0.05)。Logistic回归分析结果显示高血压、糖尿病、Hp感染是颈动脉粥样硬化斑块易损性的危险因素(P<0.05)。结论 Hp感染可增强颈动脉粥样硬化患者TLR4和NF-κB表达水平、炎症反应,增加斑块易损风险。

OBJECTIVE To explore the influence of Helicobacter pylori(Hp) infection on Toll-like receptor 4(TLR4)/nuclear factor-kappa B(NF-κB) signaling pathways and plaques vulnerability of the patients with carotid atherosclerosis. METHODS A total of 169 carotid atherosclerosis patients with Hp infection and 147 carotid atherosclerosis patients without Hp infection who were treated in Lishui People’s Hospital from Oct 2016 to Oct 2020 were enrolled in the study and were respectively assigned as the Hp infection group and the no Hp infection group. The enrolled patients were divided into the no plaque group with 94 cases, the stable plaque group with 88 cases and the vulnerable plaque group with 134 cases according to the result of carotid artery ultrasound. The expression levels of TLR4 and NF-κB in peripheral blood mononuclear cells were detected by flow cytometry. The clinical data, expression levels of TLR4 and NF-κB, and risk factors for plaque vulnerability were observed. RESULTS The percentage of vulnerable plaque, high-sensitivity C-reactive protein(hs-CRP) level, tumor necrosis factor-α(TNF-α) level, interleukin-6(IL-6) level, TLR level, NF-κB level, arterial intima-media thickness(IMT), plaque Crouse integral(CPI) and total carotid plaque area(CPA) were significantly higher in the Hp infection group than in the no Hp infection group(P<0.05). The expression levels of TC, TG, hs-CRP, TNF-α, IL-6, TLR and NF-κB of the stable plaque group and the vulnerable plaque group were significantly higher than those of the no plaque group(P<0.05), the IMT was significantly lower in the no plaque group(P<0.05). The expression levels of TC, TG, hs-CRP, TNF-α, IL-6, TLR and NF-κB of the vulnerable plaque group were significantly higher than those of the stable plaque group(P<0.05). The proportion of the patients with diabetes mellitus, proportion of the patients with hypertension, proportion of the patients with Hp infection, IMT, CPI and CPA were significantly higher in the vulnerable plaque group than in the stable plaque group(P<0.05). The result of logistic regression analysis showed that the hypertension, diabetes mellitus and Hp infection were the risk factors for the plaque vulnerability in the patients with carotid atherosclerosis(P<0.05). CONCLUSION The Hp infection may lead to the increase of expression levels of TLR4 and NF-κB in the patients with carotid atherosclerosis, aggravate inflammatory reaction and increase the risk of plaque vulnerability.