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

摘要：

目的　研究洋地黄类药物对慢性心衰伴房颤患者Toll样受体4/核因子-κB（TLR4/NF-κB）信号通路的影响。方法　回顾性分析2019年1月至2022年12月山东省泰安荣军医院80例慢性心衰伴房颤患者临床资料，根据是否接受洋地黄类药物干预将患者分为观察组和对照组，各40例。观察组男25例、女15例，年龄（50.38±6.77）岁，小剂量洋地黄+低分子量肝素治疗；对照组男27例、女13例，年龄（51.48±7.09）岁，低分子量肝素治疗。对比两组治疗效果、治疗后半年复发率及治疗前后心功能、运动耐力、外周血单核细胞TLR4/NF-κB mRNA及蛋白表达。采用t检验、χ²检验。结果　观察组房颤复发率［10.0%（4/40）］与对照组比较［12.5%（5/40）］，差异无统计学意义（P>0.05）。观察组总有效率为100.0%（40/40），高于对照组的80.0%（32/40），差异有统计学意义（P<0.05）。两组治疗后6分钟步行距离（6MWT）、左心室射血分数（LVEF）、舒张期E峰与A峰比值（E/A）均高于治疗前，左心室舒张末内径（LVEDd）低于治疗前（均P<0.05），且观察组6MWT［（434.35±52.61）m］、LVEF［（48.84±7.27）%］、E/A［（1.42±0.32）］均显著高于对照组［（402.83±55.56）m、（44.32±6.65）%、（1.22±0.24）］，差异均有统计学意义（均P<0.05）。治疗后，观察组TLR4 mRNA［（0.71±0.11）］、NF-κB mRNA［（1.22±0.28）］、TLR4/β-actin［（1.16±0.21）］、NF-κB/β-actin［（1.05±0.14）］均低于对照组［（1.43±0.61）、（1.56±0.33）、（1.46±0.19）、（1.43±0.20）］，差异均有统计学意义（均P<0.05）。结论　洋地黄类药物用于慢性心衰伴房颤患者可有效抑制TLR4、NF-κB mRNA及蛋白表达，改善心功能，使患者预后获益。

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