血清高迁移率族蛋白B1与冠状动脉病变严重程度的相关性分析

Correlation analysis between HMGB1 and severity of coronary heart disease

目的探讨血清高迁移率族蛋白B1(high mobility group protein B1,HMGB1)与冠状动脉病变严重程度的相关性。方法选择2018年1月至2019年3月期间在北京安贞医院进行冠状动脉造影并明确诊断为冠心病的170例患者的临床资料进行回顾性分析,根据冠状动脉造影结果分为单支病变组(65例)、双支病变组(55例)、三支病变组(50例)。60名同期健康体检者设为对照组。检测各组研究对象血清HMGB1、内皮素1、C反应蛋白(C-reaction protein,CRP)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)水平,并根据Gensini评分标准评价冠状动脉病变严重程度。结果单支病变组患者血清HMGB1为(7.35±0.75)μg/L、双支病变组为(11.56±1.16)μg/L、三支病变组为(14.36±1.46)μg/L、对照组为(3.22±1.52)μg/L,组间比较差异有统计学意义(F=14.235,P<0.001)。单支病变组患者血清内皮素-1为(198.56±19.86)ng/L、双支病变组为(226.54±22.64)ng/L、三支病变组为(435.65±43.95)ng/L、对照组为(120.47±13.27)ng/L,组间比较差异有统计学意义(F=16.337,P<0.001)。单支病变组患者血清CRP为(6.21±0.61)ng/L、双支病变组为(8.54±0.84)ng/L、三支病变组为(11.36±1.16)ng/L、对照组为(3.39±1.56)ng/L,组间比较差异有统计学意义(F=15.206,P<0.001)。单支病变组患者血清LDL-C为(3.23±0.33)mmol/L、双支病变组为(4.12±0.42)mmol/L、三支病变组为(6.23±0.63)mmol/L、对照组为(2.25±1.45)mmol/L,组间比较差异有统计学意义(F=22.017,P<0.001)。单支病变组患者血清HDL-C为(4.02±0.42)mmol/L、双支病变组为(2.35±0.25)mmol/L、三支病变组为(1.79±0.29)mmol/L、对照组为(4.60±1.69)mmol/L,组间比较差异有统计学意义(F=18.564,P<0.001)。单支病变组患者Gensini评分为(10.36±2.26)分、双支病变组为(16.74±1.04)分、三支病变组为(23.36±2.36)分,组间比较差异有统计学意义(F=23.014,P<0.001)。冠心病患者血清HMGB1、内皮素-1、CRP、LDL-C水平均明显高于对照组,HDL-C水平均明显低于对照组,差异均有统计学意义(P均<0.05)。病变血管支数越多,HMGB1、内皮素1、CRP、LDL-C水平及Gensini评分越高,HDL-C水平越低。多元线性回归分析结果显示,冠心病患者血清HMGB1、内皮素1、CRP、LDL-C均为Gensini评分的危险因素(标准系数分别为0.480、0.087、0.173、0.197,t值分别为8.351、9.047、12.476、11.692,P均<0.01);HDL-C水平为Gensini评分的保护因素(标准系数-0.352、t值为16.582、P<0.001)。Pearson直线相关分析结果显示,冠心病患者血清HMGB1水平与内皮素1、CRP、LDL-C呈显著正相关(r值分别为0.536、0.659、0.724,P均<0.05),与HDL-C呈显著负相关(r=-0.669,P<0.05)。结论冠心病患者体内存在明显的炎症反应及脂代谢紊乱,外周血中HMGB1水平与冠状动脉病变严重程度存在密切关系。

Objective To explore the correlation between serum high mobility group protein B1(HMGB1)and severity of coronary artery disease.Methods From January 2018 to March 2019,170 patients who underwent coronary angiography and were definitely diagnosed with coronary heart disease in Beijing Anzhen Hospital were divided into single-vessel lesion group(65 cases),double-vessel lesion group(55 cases)and three-vessel lesion group(50 cases)according to the results of coronary angiography.Sixty healthy persons in the same period were set as the control group.The serum levels of HMGB1,endothelin-1,C-reaction protein(CRP),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C)were detected,and the severity of coronary artery disease was evaluated according to Gensini score standard.Results The serum HMGB1 of patients with single vessel disease was(7.35±0.75)μg/L,that of double vessel disease group was(11.56±1.16)μg/L,that of three vessel disease group was(14.36±1.46)μg/L,and that of control group was(3.22±1.52)μg/L.The difference between the two groups was statistically significant(F=14.235,P<0.001).The serum endothelin-1 in single vessel disease group was(198.56±19.86)ng/L,that in double vessel disease group was(226.54±22.64)ng/L,that in three vessel disease group was(435.65±43.95)ng/L,and that in control group was(120.47±13.27)ng/L.The difference between the two groups was statistically significant(F=16.337,P<0.001).The serum CRP of patients with single vessel disease was(6.21±0.61)ng/L,that of double vessel disease group was(8.54±0.84)ng/L,that of three vessel disease group was(11.36±1.16)ng/L,and that of control group was(3.39±1.56)ng/L.The difference between the two groups was statistically significant(F=15.206,P<0.001).Serum LDL-C was(3.23±0.33)mmol/L in single vessel disease group,4.12±0.42 mmol/L in double vessel disease group,(6.23±0.63)mmol/L in three vessel disease group and(2.25±1.45)mmol/L in control group.The difference between the two groups was statistically significant(F=22.017,P<0.001).Serum HDL-C was(4.02±0.42)mmol/L in single vessel disease group,(2.35±0.25)mmol/L in double vessel disease group,(1.79±0.29)mmol/L in three vessel disease group and(4.60±1.69)mmol/L in control group.The difference between the two groups was statistically significant(F=18.564,P<0.001).The Gensini score of single vessel disease group was(10.36±2.26),that of double vessel disease group was(16.74±1.04)and that of three vessel disease group was(23.36±2.36).The difference between the two groups was statistically significant(F=23.014,P<0.001).The levels of HMGB1,endothelin-1,CRP and LDL-C in patients with coronary heart disease were significantly higher than those in the control group,while the levels of HDL-C were significantly lower than those in the control group(all P<0.05).The higher the number of diseased vessels,the higher the levels of HMGB1,endothelin-1,CRP,LDL-C and Gensini score,the lower the level of HDL-C.Multiple linear regression analysis showed that HMGB1,endothelin-1,CRP and LDL-C were risk factors of Gensini score(standard coefficient was 0.480,0.087,0.173,0.197,t=8.351,9.047,12.476,11.692,all P<0.01);HDL-C level was a protective factor of Gensini score(standard coefficient-0.352,t value was 16.582,P<0.001).Pearson linear correlation analysis showed that serum HMGB1 level was positively correlated with endothelin-1,CRP and LDL-C(r=0.536,0.659,0.724,all P<0.05),and negatively correlated with HDL-C(r=-0.669,P<0.05).Conclusion There are obvious inflammatory reaction and lipid metabolism disorder in patients with coronary heart disease.The level of HMGB1 in peripheral blood is closely related to the severity of coronary artery disease.