The value of serum TLR4 and MyD88 in the diagnosis of uremia combined with heart failure

SU Xiaolin; KUANG Riyu; QIN Kai

doi:10.3969/j.issn.1002-7386.2023.24.011

Abstract：Objective To observe the clinical value of Toll-like receptor 4(TLR4)and myeloid differentiation factor 88(MyD88)in the diagnosis of uremia combined with heart failure.Methods A total of 160 uremia patients from February 2019 to February 2021 were selected as the study subjects.They were divided into uremia group(n = 96)and uremia complicated with heart failure group(n= 64)according to the presence of heart failure or not.Serum levels of TLR4 and MyD88 were detected by enzyme-linked immunosorbent assay.Serum TLR4 and MyD88 levels and cardiac function indexes,including cardiac output(CO),cardiac index(CI),and left ventricular ejection fraction(LVEF)were compared between the two groups.The correlation of serum TLR4 and MyD88 with cardiac function indexes was analyzed by Pearson correlation analysis.Multivariate logistic regression analysis was used to analyze the factors affecting uremia complicated with heart failure.The diagnostic value of serum TLR4 and MyD88 levels in uremia combined with heart failure was evaluated by the receiver operating characteristic(ROC)curves.Results Serum TLR4[(5.66±0.63)μg/L vs(3.91±0.56)μg/L]and MyD88[(2.79±0.46)vs(1.01±0.31)]inpatientsofuremiacomplicatedwithheartfailuregroupweresignificantlyhigher than those of the uremia group,while CO,CI and LVEF were significantly lower(t=7.364-29.255,all P<0.05).Serum TLR4 and MyD88 levels in patients with the New York Heart Association(NYHA)Functional Classification of grade IV were significantly higher than those in patients with NYHA grade Ⅱ and Ⅲ(t=7.175-23.020,P<0.05).Serum TLR4 and MyD88 levels were significantly negatively correlated with CO,CI and LVEF(r=-0.521～0.705,all P<0.05).Increased serum TLR4(OR=1.451,95%CI:1.120-1.879),MyD88(OR=1.442,95%CI:1.096-1.897)were independent risk factors affecting the occurrence of uremia complicated with heart failure.The area under the curve(AUC)of the combined diagnosis of serum TLR4 and MyD88 was 0.892(0.858-0.948),which was significantly larger than that of a single detection of TLR4 0.783(0.734-0.829)and MyD88 0.816(0.760-0.847).The sensitivity and specificity of the combined detection was 0.872,and 0.755,respectively.Conclusion Serum TLR4 and MyD88 levels in patients with uremia complicated with heart failure are elevated,which are significantly correlated with the cardiac function.The combined detection of serum TLR4 and MyD88 have a high evaluation value for uremia complicated with heart failure.