关键词:

慢性心力衰竭, 房颤, 洋地黄, 低分子量肝素, TLR4/NF-κB信号通路

Abstract:

Objective　To investigate the effect of digitalis on Toll like receptor 4 (TLR4) / nuclear factor (NF)-κB signaling pathway in patients with chronic heart failure and atrial fibrillation. Methods　The clinical data of 80 patients with chronic heart failure and atrial fibrillation in Tai'an Disabled Soldiers' Hospital of Shandong Province from January 2019 to December 2022 were retrospectively analyzed. The patients were divided into an observation group (40 cases, low-dose digitalis + low molecular weight heparin) and a control group (40 cases, low molecular weight heparin) according to whether they received the intervention of digitalis. The observation group included 25 males and 15 females, aged (50.38±6.77) years; the control group included 27 males and 13 females, aged (51.48±7.09) years. The therapeutic effects and recurrence rates 6 months after treatment of the two groups were compared. The cardiac function, exercise endurance, and mRNA and protein expressions of TLR4/NF-κB in peripheral blood monocytes of the two groups were recorded before and after treatment. t test and χ² test were used. Results　The recurrence rate of atrial fibrillation in the observation group [10.0% (4/40)] was not significantly different from that in the control group [12.5% (5/40)] (P>0.05). The total effective rate of the observation group was higher than that of the control group [100.0% (40/40) vs. 80.0% (32/40)], with a statistically significant difference (P<0.05). After treatment, the 6-minute walking distance (6MWT), left ventricular ejection fraction (LVEF), and ratio of peak E to peak A in diastolic period (E/A) were all higher than those before treatment in both groups, and the left ventricular end-diastolic inner diameter (LVEDd) was lower than that before treatment (all P<0.05). Moreover, the 6MWT [(434.35±52.61) m], LVEF [(48.84±7.27)%], and E/A [(1.42±0.32)] in the observation group were significantly higher than those in the control group [(402.83±55.56) m, (44.32±6.65)%, and (1.22±0.24)], with statistically significant differences (all P<0.05). After treatment, the TLR4 mRNA [(0.71±0.11)], NF-κB mRNA [(1.22±0.28)], TLR4/β-actin [(1.16±0.21)], and NF-κB/β-actin [(1.05±0.14)] in the observation group were lower than those in the control group [(1.43±0.61), (1.56±0.33), (1.46±0.19), and (1.43±0.20)], with statistically significant differences (all P<0.05). Conclusion　Digitalis can effectively inhibit the mRNA and protein expressions of TLR4 and NF-κB in patients with chronic heart failure and atrial fibrillation, improve their cardiac function, and benefit their prognosis.

Key words:

Chronic heart failure, Atrial fibrillation, Digitalis, Low molecular weight heparin, TLR4/NF-κB signaling pathway