慢性心衰合并肺部感染患者TLR7和IL-23与IL-17信号通路及心脏功能

TLR7/IL-23/IL-17 signaling pathway and cardiac function in patients with chronic heart failure and pulmonary infection

目的探讨慢性心衰合并肺部感染对Toll样受体7(TLR7)和白细胞介素-23(IL-23)与IL-17信号通路及心脏功能的影响。方法回顾性选取2020年1月-2022年1月新乡市中心医院收治的300例慢性心衰患者为对象,根据住院期间肺部感染情况分为感染组134例和未感染组166例;采用酶联免疫吸附法检测IL-23、IL-17水平,荧光定量检测法检测外周血TLR7-mRNA表达量,超声检查评估患者心功能。结果感染组共培养分离病原菌156株,其中革兰阴性菌98株占62.82%,革兰阳性菌48株占30.77%,真菌10株占6.41%;感染组TLR7低于未感染组,IL-23、IL-17高于未感染组(P<0.05);感染组左室射血分数(LVEF)低于未感染组,左室收缩末期容积指数(LVESVI)、左室舒张末期容积指数(LVEDVI)高于未感染组(P<0.05);感染组中,心功能Ⅳ级患者TLR7水平低于Ⅱ级、Ⅲ级患者,IL-23、IL-17水平高于Ⅱ级、Ⅲ级患者,Ⅲ级患者IL-23、IL-17水平高于Ⅱ级患者(P<0.05);感染组心血管不良事件发生率(17.16%)高于未感染组的5.47%(P<0.05)。结论慢性心衰合并肺部感染患者IL-23、IL-17水平升高,但TLR7表达下降;肺部感染可抑制TLR7表达,而促进IL-23/IL-17信号通路活化,并进一步加重心功能受损,增加心血管不良事件发生风险。

OBJECTIVE To observe the effect of pulmonary infection on the Toll-like receptor 7/interleukin-23/interleukin-17(TLR7/IL-23/IL-17)signaling pathway and cardiac function of the patients with chronic heart failure.METHODS Three hundred patients with chronic heart failure who were admitted to Xinxiang Central Hospital from Jan.2020 to Jan.2022 were retrospectively selected as the study subjects,and were divided into 134 cases in the infected group and 166 cases in the uninfected group according to the situation of pulmonary infection during hospitalization.The levels of IL-23 and IL-17 were detected by enzyme-linked immunosorbent assay,peripheral blood TLR7mRNA expression level was detected by fluorescence quantitative method,and the cardiac function of the patients were assessed by ultrasonography.RESULTS A total of 156 pathogenic bacteria strains were cultured and isolated in the infected group,of which 98 strains of gram-negative bacteria accounted for 62.82%,48 strains of gram-positive bacteria accounted for 30.77%,and 10 strains of fungi accounted for 6.41%.The TLR7 in the infected group was lower than that in the uninfected group,while the IL-23 and IL-17 were higher than those in the uninfected group(P<0.O5).The left ventricular ejection fraction(LVEF)in the infected group was lower than that in the uninfected group,while the left ventricular end-systolic volume index(LVESVI)and left ventricular end-diastolic volume index(LVEDVI)were higher than those in the uninfected group(P<0.05).In the infected group,the level of TLR7 in patients with grade IV cardiac function was lower than those in patients with grade II and grade II cardiac function.The levels of IL-23 and IL-17 were higher than those in patients with grade II and grade II cardiac function.The levels of IL-23 and IL-17 in patients with grade II cardiac function were higher than those in patients with grade I cardiac function(P<0.05).The incidence of adverse cardiovascular events(17.16%)in the infected group was,higher than 5.47%in the uninfected group(P<0.05).CONCLUSION Patients with chronic heart failure combined with pulmonary infection had elevated levels of IL-23 and IL-17,but decreased TLR7 expression.Pulmonary infection inhibited the expression of TLR7 and promoted the activation of IL-23/IL-17 signaling pathway,which further aggravated cardiac function damage and increased the risk of adverse cardiovascularevents.