冠心病PCI术患者HMGB1、BNP水平变化及与发生心力衰竭的关系

The changes of HMGB1 and BNP levels in patients with coronary heart disease after PCI and their relationship with incidence of heart failure

目的探讨冠心病经皮冠状动脉介入术(PCI)患者高迁移率族蛋白1(HMGB1)、脑钠肽(BNP)水平变化及与发生心力衰竭(HF)的关系。方法选取收治的冠心病PCI患者100例,依据院内发生HF情况分为HF组(n=24例)和无HF组(n=76例),收集所有患者超声心动图及血生化检查资料,检测HMGB1、BNP水平并分析其与发生HF的关系。结果 HF组左心室收缩期末内径(LVDS)、HMGB1、BNP水平明显高于无HF组,HF组左心室射血分数(LVEF)水平明显低于无HF组,差异有统计学意义(P <0. 05); Logistic多因素分析结果显示,LVDS、HMGB1、BNP高水平和LVEF低水平是患者院内发生HF的危险因素(P <0. 05); Pearson相关性分析结果显示,HMGB1与LVDS、BNP呈正相关及与LVEF呈负相关,BNP与LVDS呈正相关及与LVEF呈负相关(P <0. 05); ROC曲线结果显示,在预测患者院内发生HF的敏感度、特异度、阳性预测值、阴性预测值方面,HMGB1以> 3. 0μg/L为临界值时为50. 00%、73. 68%、37. 50%、82. 35%,BNP以> 385pg/ml为临界值时为58. 33%、76. 32%、46. 67%、82. 86%,二者联合时为为91. 67%、94. 74%、84. 62%、97. 30%,二者联合时明显高于二者单独时,差异有统计学意义P <0. 05)。结论冠心病PCI患者HMGB1、BNP水平变化与院内HF的发生有关,检测二者水平对HF发生有重要的预测价值,且二者联合时具有更佳的预测效能。

Objective To investigate the changes of high mobility group box 1(HMGB1)and brain natriuretic peptide(BNP)levels in patients with coronary heart disease after percutaneous coronary intervention(PCI)and their relationship with incidence of heart failure(HF).Methods A total of 100 patients with coronary heart disease who were admitted and treated by PCI in our hospital from December 2014 to December 2017 were enrolled in the study.According to the incidence of HF in hospital,these patients were divided into HF group(n=24)and non HF group(n=76).The data of echocardiography and blood biochemical examination were collected,and the levels of HMGB1 and BNP were detected,moreover,the relationship between the levels of HMGB1,BNP and incidence of HF was analyzed.Results The levels of left ventricular end-systolic diameter(LVDS),HMGB1 and BNP in HF group were significantly higher than those in non HF group(P<0.05),however the levels of left ventricular ejection fraction(LVEF)in HF group were significantly lower than thoes in non HF group(P<0.05).Logistic multiple-factor analysis results showed that high levels of LVDS,HMGB1,BNP and low levels of LVEF were the risk factors of occurrence of HF in hospital(P<0.05).Pearson correlation analysis results showed that the HMGB1 levels were positively correlated with those of LVDS and BNP,which were negatively correlated with those of LVEF,moreover the BNP levels were positively correlated with those of LVDS and negatively correlated with those of LVEF(P<0.05).The ROC curve results showed that the predicting sensitivity,specificity,positive predictive value,negative predictive value for occurrence of HR in hospital,when taking HMGB1 >3.0μg/L as the critical value,were 50.00%,73.68%,37.50%,82.35%,respectively,when taking BNP >385pg/ml as critical value,which were 58.33%,76.32%,46.67%,82.86%,respectively.When combining the two factors,which were 91.67%,94.74%,84.62%,97.30%,respectively.The predicting values by combining the two factors were superior to those by single factor(P<0.05).Conclusion The changes of HMGB1 and BNP levels in patients with coronary heart disease after PCI are related to the occurrence of HF in hospital,the combination detection of the two factors has important predictive value for the occurrence of HF,moreover the combination detection of the two factors has better prediction efficacy.