冠心病病人血清HMGB1与hs-CRP变化及临床意义

THE CHANGES AND REALTED CLINICAL SIGNIFICANCE IN SERUM LEVELS OF HIGH-MOBILITY GROUP BOX 1 PROTEIN AND HYPERSENSITIVE C-REACTIVE PROTEIN IN PATIENTS WITH CORONARY HEART DISEASE

目的探讨冠心病（CHD）病人血清高迁移率族蛋白B1（HMGB1）和超敏C反应蛋白（hs-CRP）的变化及其临床意义。方法采用ELISA法和散射速率比浊法,测定60例不同类型CHD病人血清HMGB1和hs-CRP浓度变化,并与20例健康体检者（对照组）进行比较。结果 CHD病人血清HMGB1和hs-CRP水平明显增高,与对照组比较差异有显著性（t′=8.02、8.43,P〈0.01）。急性心肌梗死（AMI）病人血清HMGB1和hs-CRP水平均显著高于不稳定型心绞痛（UAP）病人、稳定型心绞痛（SAP）病人和对照组（F=31.48、24.60,q=4.32~12.84,P〈0.01）;UAP病人血清HMGB1和hs-CRP水平显著高于SAP病人和对照组（q=3.98~8.51,P〈0.01）;SAP病人血清HMGB1和hs-CRP水平与对照组比较差异亦有显著性（q=3.63、2.90,P〈0.05）。CHD病人血清HMGB1和hs-CRP水平呈正相关（r=0.287,P〈0.05）。血清HMGB1和hs-CRP水平在AMI、UAP组AUCROC均大于0.90,对AMI诊断的灵敏度和特异度分别为0.90、0.95和0.85、0.95,对UAP诊断的灵敏度和特异度分别为0.95、0.85和0.90、0.90。结论血清HMGB1和hs-CRP浓度的变化对AMI和UAP具有明显的诊断价值和较高的诊断准确度,可以作为评价CHD危险程度的指标之一。

Objective To explore the changes of serum levels of high-mobility group box l protein（HMGB1） and hypersensitive C-reactive protein（hs-CRP） in patients with coronary heart disease（CHD） and to discuss the related clinical significance.Methods The serum levels of HMGB1 and hs-CRP were detected by enzyme-linked immunosorbent assay and scatter velocity turbidimetry,respectively,among 60 patients with different types of CHD.The data obtained were compared with 20 healthy controls. Results The serum HMGB1 and hs-CRP of the CHD patients were significantly higher than that of the controls（t′=8.02,8.43;P0.01）.The serum HMGB1 and hs-CRP of patients with acute myocardial infarction（AMI） were obviously higher than that of the patients with unstable angina pectoris（UAP）,or those with stable angina pectoris（SAP） or of the controls（F=31.48,24.60;q=4.32-12.84;P0.01）.The serum HMGB1 and hs-CRP of UAP patients were much higher than that of those with SAP and of the controls（q=3.98-8.51,P0.01）;while the difference of serum HMGB1 and hs-CRP between SAP patients and the controls was also statistically different（q=3.63,2.90;P0.05）.There was a positive correlation between serum HMGB1 and hs-CRP in patients with CHD（r=0.287,P0.05）.The areas under the ROC curve（AUCROC） were all greater than 0.90.The sensitivity and specificity of HMGB1 and hs-CRP were 0.90,0.95 and 0.85,0.95 in patients with AMI.The sensitivity and specificity of HMGB1 and hs-CRP were 0.95,0.85 and 0.90,0.90 in patients with UAP. Conclusion The changes in serum levels of HMGB1 and hs-CRP are of higher accuracy in the diagnosis of patients with AMI or UAP,which can be used as one of the criteria to evaluate the risk of CHD.