摘要
目的:探讨血清高迁移率族蛋白B1(HMGB1)、可溶性晚期糖基化终产物受体(sRAGE)水平对急性失代偿性心力衰竭(ADHF)患者预后的评估价值。方法:选取190例ADHF患者为研究组,另选取191例健康者为对照组,根据1年随访期是否死亡,将ADHF患者分为预后不良组(58例)和预后良好组(132例);采用酶联免疫吸附法(ELISA)检测血清HMGB1、sRAGE水平;采用Pearson法分析血清HMGB1、sRAGE水平与心功能指标及实验室指标的相关性;采用受试者工作特征(ROC)曲线分析HMGB1、sRAGE及血浆N端脑钠肽前体(NT-proBNP)对ADHF患者预后的评估价值;采用多因素Logistic回归分析影响ADHF患者预后的因素。结果:与对照组比较,研究组患者血清HMGB1、sRAGE水平更高(P均<0.05);预后良好组与不良组血清HMGB1、sRAGE水平、纽约心脏病协会(NYHA)分级、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、NT-proBNP、血清肌钙蛋白I(cTnI)、住院时间比较,差异有统计学意义(P均<0.05)。经Pearson法分析,ADHF患者血清HMGB1、sRAGE分别与LVEDD、LVESD、NT-proBNP、cTnl呈正相关,与LVEF呈负相关(P均<0.05),血清HMGB1与sRAGE呈正相关(P<0.05)。ROC曲线分析显示,HMGB1、sRAGE、NT-proBNP对ADHF患者预后不良评估价值均较高,AUC分别为0.869、0.852、0.844,最佳截断值分别为32.91 g/L、296.46 ng/L、3809.77 ng/L时,灵敏度分别为79.3%、82.8%、82.8%,特异性分别为83.3%、74.2%、79.5%。多因素logistic回归分析表明,NYHA分级、LVEF、NT-proBNP、HMGB1及sRAGE是ADHF患者预后的独立危险因素(P均<0.05)。结论:血清HMGB1、sRAGE表达与ADHF的发生及预后有关,可作为ADHF患者预后的评估指标。
Objective:To investigate the value of serum high mobility group protein box1(HMGB1) and soluble receptor of advanced glycation end product(sRAGE) levels in the prognostic evaluation of acute decompensated heart failure(ADHF).Methods:Totally,190 ADHF patients were regarded as the research group.In addition,191 healthy people who were examined in our hospital were served as the control group.All ADHF patients were divided into a poor prognosis group(58 cases) and a good prognosis group(132 cases) according to whether they died during the 1-year follow-up period.Enzyme-linked immunosorbent assay(ELISA) was used to detect the expression levels of serum HMGB1 and sRAGE.The cardiac function indexes and laboratory indexes of the patients in this group were collected.The Pearson method was used to analyze the correlation between serum HMGB1 and sRAGE levels and cardiac function indexes and laboratory indexes in ADHF patients.The ROC curve was used to analyze the predictive value of HMGB1 and sRAGE in assessing the poor prognosis of ADHF patients.The multivariate Logistic regression was used to analyze the related factors affecting the poor prognosis of ADHF patients.Results:As compared with the control group,the levels of serum HMGB1 and sRAGE in the study group were obviously increased(P<0.05).As compared with the good prognosis group,the levels of serum HMGB1 and sRAGE in the poor prognosis group were obviously increased(P<0.05).There were obvious differences in NYHA classification,LVESD,LVEDD,LVEF,NT-proBNP,cTnl,and length of hospital stay of ADHF patients between the good prognosis group and the poor prognosis group(P<0.05).The Pearson analysis showed that serum HMGB1 and sRAGE in ADHF patients were positively correlated with LVEDD,LVESD,NT-proBNP,and cTnl,respectively,and negatively correlated with LVEF(P<0.05),and serum HMGB1 and sRAGE in ADHF patients were positively correlated(P<0.05).The Pearson's analysis revealed that serum HMGB1 and sRAGE in ADHF patients were positively correlated with LVEDD,LVESD,NT-proBNP and cTnl,and negatively correlated with LVEF(P<0.05).Serum HMCB1 was positively correlated with sRACE(P<0.05).The ROC curve analysis showed that the AUC of HMGB1,sRAGE and NT-proBNP for poor prognosis in ADHF patients was 0.869(0.814-0.924),0.852(0.794-0.911) and 0.844(0.778-0.911),respectively,and the best diagnostic cut-off value was 32.91 g/L,296.46 ng/L and 3809.77 ng/L,respectively,with the corresponding sensitivity being 79.3%,82.8% and 82.8%,respectively,and the specificity being 83.3%,74.2% and 79.5%,respectively.Multivariate logistic regression analysis showed that the cardiac function class,LVEF,NT-proBNP,HMGB1 and sRAGE were independent risk factors for prognosis in ADHF patients(P<0.05).Conclusion:The expression of HMGB1 and sRAGE is related to the occurrence and prognosis of ADHF,and can be used as an auxiliary indicator of the prognosis of ADHF patients.
作者
毛周琳
刘云
沈勰
MAO Zhou-lin;LIU Yun;SHEN Xie(Department of Emergency,Suzhou Ninth Hospital Affiliated to Soochow University(Suzhou Ninth People's Hospital),Jiangsu Suzhou 215299,China)
出处
《内科急危重症杂志》
2024年第1期31-34,63,共5页
Journal of Critical Care In Internal Medicine
