外周血高迁移率族蛋白1与急性心肌梗死介入治疗术后无复流的关系研究

Relationship between high mobility group protein box-1 level in peripheral blood and no-reflow in patients with acute myocardial infarction after interventional therapy

目的探讨外周血高迁移率族蛋白1(high mobility group protein box-1,HMGB1)与急性心肌梗死患者介入治疗术后发生无复流的关系。方法选择2019年10月至2020年10月在柳州市人民医院接受介入治疗的急性心肌梗死患者120例为研究对象,根据介入治疗后冠脉复流情况分为正常血流组(78例)和无复流组(42例)。比较两组患者临床基本资料和实验室检测结果,用酶联免疫吸附测定(ELISA)法检测两组患者外周血中HMGB1的水平并进行比较,用受试者工作特征曲线(ROC)分析HMGB1对无复流的诊断价值。结果无复流组与正常血流组年龄、性别、高血压病史、吸烟史、既往冠心病史、肌酸激酶同工酶(CK-MB)峰值均差异无统计学意义(均P>0.05)。无复流组合并糖尿病例数、多支血管病变比例、C反应蛋白(CRP)水平、脑钠肽(BNP)水平均高于正常血流组,均差异有统计学意义(均P<0.05)。ELISA结果显示无复流组的HMGB1水平为(5.2±0.85)mg/L,正常血流组的HMGB1水平为(3.2±0.9)mg/L,差异有统计学意义(t=-2.38,P=0.02)。用ROC曲线比较HMGB1、BNP和CRP对无复流的诊断价值,结果显示HMGB1、BNP和CRP的AUC值分别为0.746(0.661~0.830)、0.605(0.504~0.705)、0.688(0.595~0.781),其中HMGB1的AUC值最大。结论HMGB1水平在急性心肌梗死无复流患者中明显上升,对无复流具有较高的诊断价值。

Objective To investigate the relationship between high mobility group protein box-1(HMGB1)level in peripheral blood and no-reflow in patients with acute myocardial infarction after interventional therapy.Methods 120 patients with acute myocardial infarction patients who received interventional treatment in Liuzhou People's Hospital,China between October 2019 and October 2020 were included in this study.They were divided into normal blood flow group(n=78)and no-reflow group(n=42)according to the situation of coronary reflow after interventional treatment.The clinical data and laboratory test results were compared between the two groups.The level of HMGB1 in peripheral blood was detected using enzyme-linked immunosorbent assay and compared between the two groups.The diagnostic value of HMGB1 in no reflow was analyzed by the receiver operating characteristic(ROC)curve.Results There were no significant differences in age,gender,history of hypertension,history of smoking,history of coronary heart disease,and peak value of creatine kinase MB between no reflow and normal flow groups(all P>0.05).The number of patients developing diabetes mellitus,the proportion of patients developing lesions of multiple vessels,C-reactive protein level and brain natriuretic peptide level in no-reflow group were significantly higher than those in the normal blood flow group(all P<0.05).Enzyme-linked immunosorbent assay results revealed that there was significant difference in HMGB1 level between no reflow and normal flow groups[(5.2±0.85)mg/L vs.(3.2±0.9)mg/L,t=-2.38,P=0.02).The ROC curve was used to compare the diagnostic values of HMGB1,brain natriuretic peptide and C-reactive protein for no reflow.The results showed that the area under the ROC curve values of HMGB1,brain natriuretic peptide and C-reactive protein were 0.746(0.661-0.830),0.605(0.504-0.705)and 0.688(0.595-0.781),respectively.The area under the ROC curve value of HMGB1 was the highest.Conclusion The level of HMGB1 is obviously increased in patients with acute myocardial infarction presenting with no reflow,which has a high diagnostic value for no reflow.