血清高迁移率族蛋白B1对胆总管结石继发性急性胆管炎的预测价值

Predictive value of serum high mobility group protein B1 for secondary acute cholangitis of choledocholithiasis.

目的探究血清高迁移率族蛋白B1(HMGB1)对胆总管结石继发性急性胆管炎的预测价值。方法选取朱家角人民医院2018年1月至2021年11月收治的206例胆总管结石患者为研究对象,根据胆总管结石患者是否发生急性胆管炎分为继发急性胆管炎组74例和单纯胆总管结石组132例。采用酶联免疫吸附(ELISA)法检测所有患者血清中HMGB1水平。采用Pearson法分析HMGB1水平与白细胞计数、C反应蛋白、糖链抗原199(CA199)、糖链抗原125(CA125)的相关性;采用受试者工作特征曲线(ROC)评价血清HMGB1、CA199、CA125对胆总管结石患者发生急性胆管炎的预测价值。应用多因素Logistic回归分析影响胆总管结石患者发生急性胆管炎的危险因素。结果单纯胆总管结石组和继发急性胆管炎组患者的血清白细胞计数[(6.73±1.87)×10^(9)/L vs(9.11±2.38)×10^(9)/L]、C反应蛋白[(55.43±13.74)µg/mL vs(79.49±17.66)µg/mL]、CA199[(37.49±12.14)U/mL vs(80.05±21.91)U/mL]、[CA125(18.76±4.57)U/mL vs(33.47±7.12)U/mL]、HMGB1[(7.16±1.72)µg/L vs(15.42±3.67)µg/L]水平比较,继发急性胆管炎组患者明显高于单纯胆总管结石组,差异均有统计学意义(P<0.05);经Pearson法分析结果显示,血清HMGB1与白细胞计数、C反应蛋白呈正相关(r=0.616,r=0.576,P<0.05);经ROC曲线分析结果显示,血清HMGB1预测胆总管结石患者发生急性胆管炎的曲线下面积(AUC)为0.875,其敏感度、特异性分别为85.10%、87.90%;经多因素Logistic回归分析结果显示,白细胞计数、C反应蛋白、CA199、CA125、HMGB1是胆总管结石患者发生急性胆管炎的危险因素(P<0.05)。结论胆总管结石继发性急性胆管炎患者血清HMGB1水平显著上升,其对胆总管结石患者发生急性胆管炎有较好的预测价值。

Objective To explore the predictive value of serum high mobility group protein B1(HMGB1)for secondary acute cholangitis of choledocholithiasis.Methods A total of 206 patients with choledocholithiasis admitted to Zhujiajiao People's Hospital from January 2018 to November 2021 were selected as the research objects.According to whether the patients with choledocholithiasis had acute cholangitis,they were divided into secondary acute cholangitis group(n=74)and simple choledocholithiasis group(n=132).Enzyme-linked immunosorbent(ELISA)method was used to detect the level of HMGB1 in the serum of all subjects.Pearson method was used to analyze the correlation between HMGB1 level and white blood cell count,C-reactive protein,carbohydrate antigen 199(CA199),carbohydrate antigen 125(CA125).Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum HMGB1,CA199,CA125 on the occurrence of acute cholangitis in patients with choledocholithiasis.Multivariate Logistic regression analysis was used to analyze the risk factors of acute cholangitis in patients with choledocholithiasis.Results The serum white blood cell count,C-reactive protein,CA199,CA125,HMGB1 were(6.73±1.87)×10^(9)/L,(55.43±13.74)µg/mL,(37.49±12.14)U/mL,(18.76±4.57)U/mL,and(7.16±1.72)µg/L in the simple choledocholithiasis group,which were significantly lower than(9.11±2.38)×10^(9)/L,(79.49±17.66)µg/mL,(80.05±21.91)U/mL,(33.47±7.12)U/mL,and(15.42±3.67)µg/L in the secondary acute cholangitis group(P<0.05).Pearson analysis showed that serum HMGB1 was positively correlated with white blood cell count and C-reactive protein(r=0.616,r=0.576,P<0.05).The ROC curve showed that the area under the curve(AUC)of serum HMGB1 predicting acute cholangitis in patients with choledocholithiasis was 0.875,and its sensitivity and specificity were 85.10%and 87.90%,respectively.Multivariate Logistic regression analysis showed that white blood cell count,C-reactive protein,CA199,CA125,and HMGB1 were risk factors for acute cholangitis in patients with choledocholithiasis(P<0.05).Conclusion The level of serum HMGB1 in patients with secondary acute cholangitis of choledocholithiasis increases significantly,which has a good predictive value for the occurrence of acute cholangitis in patients with choledocholithiasis.