The Role of High-Mobility Group Box 1/Toll-Like Receptor 4 in Pericardial Fibrosis and Postoperative Low Cardiac Output Syndrome in Constrictive Pericarditis.

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiology Research Pub Date : 2026-06-05 eCollection Date: 2026-06-01 DOI:10.14740/cr2228

Li Kui Fang, Tian Xiang Wang, Fang Ming Zhong, Guo Can Yu, Wei Hua Li

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引用次数: 0

Abstract

Background: It has remained unclear about the factors that are involved in the pericardial fibrotic process and the occurrence of postoperative low cardiac output syndrome (LCOS) in constrictive pericarditis. This study aimed to analyze the role of toll-like receptor 4 (TLR4) and high-mobility group box 1 (HMGB1) in pericardial fibrosis, and their impact on the development of postoperative LCOS in patients with constrictive pericarditis.

Methods: This retrospective study enrolled 24 constrictive pericarditis patients who underwent isolated pericardiectomy at our department from May 2023 to April 2025. Pericardial tissues were subjected to immunohistochemistry to detect the expression of TLR4, HMGB1, α-smooth muscle actin (α-SMA) and collagen III. Mean optical density (MOD) was used for quantitative analysis of immunohistochemical staining. Pearson correlation analysis was performed to assess associations between TLR4, HMGB1 and fibrotic markers, while receiver operating characteristic (ROC) curves were used to evaluate their potential predictive value for postoperative LCOS.

Results: Of the 24 patients, seven (29.2%) patients developed postoperative LCOS. TLR4 was expressed in 21 (87.5%) specimens, and HMGB1 was expressed in all specimens. Pearson correlation analysis showed positive correlations between TLR4 and α-SMA (r = 0.529, P = 0.008), HMGB1 and α-SMA (r = 0.516, P = 0.010), and TLR4 and HMGB1 (r = 0.844, P < 0.001). MOD values of TLR4 and HMGB1 were significantly higher in patients with postoperative LCOS (P = 0.028 and P < 0.001, respectively). ROC curve suggested that TLR4 (area under the curve (AUC) = 0.790, 95% confidence interval (CI), 0.516-1.000) and HMGB1 (AUC = 0.941, 95% CI, 0.853-1.000) had potential predictive value for postoperative LCOS.

Conclusions: TLR4 and HMGB1 were involved in the pericardial fibrosis and were significantly associated with the occurrence of postoperative LCOS in constrictive pericarditis.

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高迁移率组盒1/ toll样受体4在缩窄性心包炎患者心包纤维化和术后低心输出量综合征中的作用

背景：缩窄性心包炎患者心包纤维化过程及术后低心输出量综合征（LCOS）发生的相关因素尚不清楚。本研究旨在分析toll样受体4 （toll-like receptor 4, TLR4）和高迁移率组盒1 （high-mobility group box 1, HMGB1）在缩窄性心包炎患者心包纤维化中的作用及其对术后LCOS发展的影响。方法：本回顾性研究纳入了2023年5月至2025年4月在我科行孤立性心包炎切除术的24例缩窄性心包炎患者。采用免疫组化方法检测心包组织TLR4、HMGB1、α-平滑肌肌动蛋白（α-SMA）、III型胶原蛋白的表达。免疫组织化学染色定量分析采用平均光密度（MOD）法。采用Pearson相关分析评估TLR4、HMGB1与纤维化标志物之间的相关性，采用受试者工作特征（ROC）曲线评估其对术后LCOS的潜在预测价值。结果：24例患者中，7例（29.2%）发生术后LCOS。21例（87.5%）标本中表达TLR4， HMGB1在所有标本中表达。Pearson相关分析显示，TLR4与α-SMA呈正相关（r = 0.529, P = 0.008）， HMGB1与α-SMA呈正相关（r = 0.516, P = 0.010）， TLR4与HMGB1呈正相关（r = 0.844, P < 0.001）。TLR4和HMGB1的MOD值在术后LCOS患者中显著升高（P = 0.028, P < 0.001）。ROC曲线提示TLR4(曲线下面积（AUC) = 0.790, 95%可信区间（CI） 0.516 ~ 1.000）和HMGB1 （AUC = 0.941, 95% CI 0.853 ~ 1.000）对术后LCOS具有潜在的预测价值。结论：TLR4和HMGB1参与了缩窄性心包炎患者心包纤维化的发生，并与术后LCOS的发生显著相关。

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来源期刊

Cardiology Research CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

2.50

自引率

0.00%

发文量

期刊介绍： Cardiology Research is an open access, peer-reviewed, international journal. All submissions relating to basic research and clinical practice of cardiology and cardiovascular medicine are in this journal''s scope. This journal focuses on publishing original research and observations in all cardiovascular medicine aspects. Manuscript types include original article, review, case report, short communication, book review, letter to the editor.