慢性心力衰竭合并肺部感染外周血miR-21、Tim-3、MMP-9、TLR4/NF-κB表达

Expressions of miR-21,Tim-3,MMP-9 and TLR4/NF-κB pathway in peripheral blood of chronic heart failure patients complicated with pulmonary infection

目的探究慢性心力衰竭合并肺部感染外周血微小核糖核酸(miR)-21、T细胞免疫球蛋白黏蛋白分子3(Tim-3)mRNA、基质金属蛋白酶-9(MMP-9)、Toll-样受体4/核因子κB(TLR4/NF-κB)通路表达意义。方法选取滨州医学院附属医院2021年7月一2023年7月收治的慢性心力衰竭患者121例为研究对象,将发生肺部感染和未发生肺部感染的患者分别纳人感染组35例和非感染组86例。统计感染组病原菌分布,比较两组血清miR-21、Tim-3、MMP-9、TLR4、NF-κB水平,miR-21、Tim-3、MMP-9、TLR4、NF-κB水平,受试者工作特征(ROC)曲线分析其对慢性心力衰竭合并肺部感染的预测价值。结果感染组分离出48株病原菌,革兰阴性菌占比最高,以大肠埃希菌为主。感染组血清miR-21、Tim-3、MMP-9、TLR4、NF-κB水平高于非感染组(P<0.05)。miR-21、Tim-3、MMP-9、TLR4、NF-κB联合检测诊断慢性心力衰竭患者合并肺部感染的曲线下面积(AUC)比各指标单一检测高(P<0.05),且联合检测敏感度、特异度为94.29%、83.72%。结论革兰阴性菌为慢性心力衰竭合并肺部感染的主要病原菌,慢性心力衰竭合并肺部感染患者血清miR-21、Tim-3及MMP-9水平呈高表达,TLR4/NF-κB信号通路被激活;miR-21、Tim-3、MMP-9、TLR4、NF-κB五指标联合检测可提高慢性心力衰竭患者合并肺部感染预测价值。

OBJECTIVE To explore the expressions of peripheral blood microribonucleic acid(miR)-21,T cell im-munoglobulin mucin-3(Tim-3)mRNA,matrix metalloproteinase-9(MMP-9),Toll-like receptor 4/nuclear fac-torκB(TLR4/NF-κB)pathway in the chronic heart failure(CHF)patients complicated with pulmonary infection and analyze the significance.METHODS A total of 121 patients with CHF who were treated in Binzhou Medical College Affiliated Hospital from Jul 2021 to Jul 2023 were recruited as the research subjects and were divided into the infection group with 35 cases and the non-infection group with 86 cases according to the status of pulmonary infection.The distribution of pathogens isolated from the infection group was statistically analyzed.The levels of serum miR-21,Tim-3,MMP-9,TLR4 and NF-κB were compared between the two groups,and the values of the indexes in prediction of pulmonary infection in the CHF patients were analyzed by means of receiver operating characteristic(ROC)curves.RESULTS Totally 48 strains of pathogens were isolated from the infection group,among which gram-negative bacteria were dominant,and the Escherichia coli was the predominant species.The levels of serum miR-21,Tim-3,MMP-9,TLR4 and NF-κB of the infection group were significantly higher than those of the non-infection group(P<0.05).The area under curve(AUC)of the joint detection of miR-21,Tim-3,MMP-9,TLR4 and NF-κB was significantly higher than that of the single detection in diagnosis of pulmonary infection of the patients with CHF(P<0.05),the sensitivity of the joint detection was 94.29%,with the specificity 83.72%.CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the CHF patients complicated with pulmonary infection,the patients show the high expressions of serum miR-21,Tim-3 and MMP-9,the TLR4/NF-κB signaling pathway is activated.The joint detection of miR-21,Tim-3,MMP-9,TLR4 and NF-κB has high value in prediction of pulmonary infection of the CHF patients.