高迁移率族蛋白B1水平与急性脑梗死病情严重程度及预后的关联研究

Correlations of high mobility group protein box-1 level with severity and prognoses of acute cerebral infarction

目的探讨血清高迁移率族蛋白B1(HMGB1)水平与急性脑梗死病情严重程度及预后之间的关系。方法选择自2018年4月至10月于江阴市人民医院神经内科住院诊治的300例急性脑梗死患者(急性脑梗死组)及122例同期门诊体检健康者(对照组)为研究对象,其中急性脑梗死组患者根据入院时美国国立卫生研究院卒中量表(NIHSS)评分分为轻度脑梗死组(NIHSS评分<5分)(n=100)、中度脑梗死组(NIHSS评分5~15分)(n=100)和重度脑梗死组(NIHSS评分≥16分)(n=100),根据随访3个月时改良Rankin量表(mRS)评分分为预后良好组(mRS评分≤2分)(n=170)和预后不良组(mRS评分>2分)(n=130)。采用酶联免疫吸附法及全自动生化检测仪检测各组受试者血清HMGB1、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)等指标水平,采用Pearson相关性分析及受试者工作特征曲线(ROC)分析血清HMGB1水平与其他指标的相关性及评估其对预后不良的预测价值。结果急性脑梗死组血清HMGB1水平明显高于对照组[(7.98±3.99)μg/L vs.(4.61±1.02)μg/L],且重度脑梗死组明显高于中度脑梗死组[(12.86±1.91)μg/L vs.(7.30±1.07)μg/L],中度脑梗死组明显高于轻度脑梗死组[(7.30±1.07)μg/L vs(3.78±0.95)μg/L],差异均有统计学意义(P<0.05)。急性脑梗死患者血清HMGB1水平与低密度脂蛋白胆固醇水平、NIHSS评分呈正相关关系(r=0.521,P=0.000;r=0.931,P=0.000),与高密度脂蛋白胆固醇水平呈负相关关系(r=-0.114,P=0.001)。预后良好组血清HMGB1水平明显低于预后不良组[(6.52±3.29)μg/L vs.(9.88±4.03)μg/L],差异有统计学意义(P<0.05),且血清HMGB1水平与mRS评分呈正相关关系(r=0.160,P=0.000)。同时,HMGB1预测急性脑梗死预后不良的曲线下面积[0.736(95%CI:0.677~0.795)]大于LDL-C预测时的曲线下面积[0.634(95%CI:0.570~0.698)]。结论急性脑梗死后血清HMGB1水平可明显升高,且与病情严重程度相关,并对预后具有一定的预测价值。

Objective To investigate the correlations of high mobility group protein box-1(HMGB1)level with severity and prognoses of acute cerebral infarction.Methods Between April 2018 and October 2018,300 patients with acute cerebral infarction and 122 healthy control subjects were enrolled.According to National Institute of Health stroke scale(NIHSS)scores,patients with acute cerebral infarction were divided into group A(NIHSS scores<5),group B(5≤NIHSS scores≤15)and group C(NIHSS scores≥16).According to modified Rankin Scale(mRS)scores,patients were divided into good prognosis group(mRS scores≤2)and poor prognosis group(mRS scores>2)after 3 months of follow up.The serum levels of HMGB1,low density lipoprotein cholesterol(LDL-C)and high density lipoprotein cholesterol(HDL-C)in different groups were detected and compared.Pearson correlation analysis and receiver operating characteristic curve were used to analyze the correlations of serum HMGB1 level with other indicators and evaluate their predictive values in poor prognosis.Results The serum HMGB1 level in the acute cerebral infarction patients was significantly higher than that in the controls([7.98±3.99]μg/L vs.[4.61±1.02]μg/L,P<0.05);the serum HMGB1 level in the group C was significantly higher than that in group B([12.86±1.91]μg/L vs.[7.30±1.07]μg/L,P<0.05),and that in group B was statistically higher than that in group A([7.30±1.07]μg/L vs.[3.78±0.95]μg/L,P<0.05).Serum HMGB1 level was positively correlated with LDL-C level and NIHSS scores(r=0.521,P=0.000;r=0.931,P=0.000),and negatively correlated with HDL-C level(r=-0.114,P=0.001).The serum HMGB1 level in good prognosis group was significantly lower than that in poor prognosis group([6.52±3.29]μg/L vs.[9.88±4.03]μg/L,P<0.05),and the serum HMGB1 level was positively correlated with mRS scores(r=0.160,P=0.000).The area under the curve of HMGB1 predicting poor prognosis of acute cerebral infarction(0.736[95%CI:0.677-0.795])was larger than that under the curve of LDL-C predicting poor prognosis of acute cerebral infarction(0.634[95%CI:0.570-0.698]).Conclusion Serum HMGB1 level in patients with acute cerebral infarction is significantly increased,which is related to severity of disease,and has certain predictive value in prognoses of acute cerebral infarction.