高迁移率族蛋白B1与急性心肌梗死的相关性分析

Correlation between high mobility group box-1 and acute myocardial infarction

摘要:

目的 探讨血清高迁移率族蛋白B1（HMGB1）水平与急性心肌梗死（AMI）的关系。方法 选取2016年1月—2018年11月于东南大学医学院附属江阴医院就诊并成功行急诊冠状动脉介入治疗的急性ST段抬高型心肌梗死患者348例，选取同期该院健康体检群众312例。记录患者从开始发病至球囊开通时间的血清HMGB1、总胆固醇、甘油三酯、LDL、HDL、肌钙蛋白I、脑钠肽（BNP）水平，通过二维超声心动图检查记录左室舒张末期内径（LVEDD）及左室射血分数（LVEF）。结果 AMI组HDL、LVEF较对照组低（P <0.05），LDL、BNP、LVEDD及HMGB1较对照组高（P <0.05）。血清HMGB1水平与球囊开通时间、LDL、BNP水平、LVEDD及肌钙蛋白Ⅰ呈正相关（r =0.896、0.667、0.647、0.623和0.781，均P <0.05），与HDL、LVEF呈负相关（r =-0.774和-0.739，均P <0.05）。AMI组HMGB1水平较对照组高（P <0.05）。HMGB1诊断曲线下面积为0.76（95% CI：0.69，0.82），HMGB1用来预测AMI后再发心房颤动的界值为7.28 μg/L，敏感性为72%（95% CI：0.67，0.77），特异性为62%（95% CI：0.57，0.67）。结论 血清HMGB1水平与AMI具有明显的相关性，并对AMI后心房颤动的发生具有诊断价值，通过监测血清HMGB1水平对AMI的诊治具有一定的临床指导意义。

Abstract:

Objective To investigate the correlation of serum high mobility group box-1 (HMGB1) level and acute myocardial infarction (AMI).Methods The 348 patients with acute ST-elevation myocardial infarction (STEMI) who underwent percutaneous coronary intervention in our hospital from January 2016 to November 2018 were selected, and another 312 healthy subjects taking physical examination were enrolled as the control group. The onset-to-balloon (OTB) time was recorded, and serum levels of HMGB1, total cholesterol, triglyceride, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), cardiac troponin I and brain natriuretic peptide (BNP) were measured. Left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) were detected by two-dimensional echocardiography.Results The HDL and LVEF were lower, but LDL, BNP, LVEDD and HMGB1 were higher in AMI group compared with control group (P < 0.05). Serum level of HMGB1 positively correlated with OTB time, LDL, BNP, LVEDD, and cardiac troponin I (r = 0.896, 0.667, 0.647, 0.623 and 0.781, respectively, all P < 0.05), but negatively correlated with HDL and LVEF (r = -0.774 and -0.739, respectively, both P < 0.05). The level of serum HMGB1 was significantly higher in AMI group than that in the control group (P < 0.05). The area under the receiver operating characteristic curve of HMGB1 for predicting the occurrence of atrial fibrillation after AMI was 0.76 (95% CI: 0.69, 0.82), and the optimal cutoff value was 7.28 μg/L, with a sensitivity of 72.0% (95% CI: 67.28%, 76.72%) and a specificity of 62.4% (95% CI: 57.31%, 67.49%).Conclusions Serum HMGB1 level is significantly correlated with AMI, and has a predictive value for the occurrence of atrial fibrillation after AMI. Monitoring the level of serum HMGB1 has certain clinical significance for the diagnosis and treatment of AMI.