高迁移率族蛋白B1与GRACE评分对行择期PCI治疗的急性冠脉综合征患者预后的影响

摘要

目的 研究高迁移率族蛋白B1与GRACE评分对行择期经皮冠状动脉介入治疗的急性冠脉综合征患者临床预后的影响.方法 连续入选2014年1月至2015年3月于心内科首次明确诊断为急性冠脉综合征的患者380例,其中低高迁移率族蛋白B1组(High Mobility Group Box1,HMGB1<445 ng/mL) 200例,高高迁移率族蛋白B1组(HMGB1≥445 ng/mL)180例,收集患者入院时的基础资料及实验室检查指标,计算患者入院时GRACE评分,分析高迁移率族蛋白低、高值组间的差异及行择期经皮冠状动脉介入治疗患者临床预后的影响因素.平均随访时间为24个月,临床终点事件是各种原因的死亡和因冠心病再入院.结果 临床诊断、脂蛋白相关磷脂酶A2、GRACE评分、血小板平均体积、红细胞分布宽度、年龄、左室射血分数在高迁移率族蛋白低、高值组间差异有统计学意义(P<0.05),相关性分析显示HMGB1水平与脂蛋白相关磷脂酶A2、GRACE评分明显相关,相关系数分别为0.575、0.836(P<0.05).COX分析显示HMGB1、脂蛋白相关磷脂酶A2、GRACE评分对生存结局差异有统计学意义(P<0.05),三者联合起来ROC曲线下面积为0.851(95%CI 0.811~0.891,P<0.05).结论 HMGB1与GRACE评分有很好的相关性,能很好的预测行择期PCI治疗的急性冠脉综合征患者临床预后.%Objective To investigate the impact of high mobility group box1 and GRACE score on the clinical prognosis of patients with acute coronary syndrome undergoing selective percutaneous coronary intervention. Methods A total of 380 consecutive patients initially diagnosed with acute coronary syndrome undergoing selec-tive PCI between January 2014 and March 2015 were included,with 200 of them assigned into low high mobility group box1(HMGB1<445 ng/mL)and the other 180 patients into high mobility group box1(HMGB1≥445 ng/mL).The baseline characteristics and laboratory indexes were collected on admission,GRACE score were calculat-ed at admission.The difference between the high and low high mobility group box1 were analzyed and the influenc-ing factors of patients with acute coronary syndrome undergoing selective percutaneous coronary intervention were studied. The mean follow-up period was 24 months,and the clinical end points were deaths from various causes and readmission for coronary heart disease. Results There were significantly differences statistically between the groups of high and low high mobility group box1 in clinical diagnosis. lipoprotein associated phospholipase A2, GRACE score,mean platelet volume,red cell distribution width,age,and left ventricular ejection fraction(P <0.05). The correlation analysis showed that HMGB1 was significantly related to lipoprotein associated phospholi-pase A2 and GRACE score,with the correlation coefficents of 0.575,0.836,respectively(P<0.05).COX analy-sis showed that HMGB1,lipoprotein associated phospholipase A2,GRACE score had statistical significance for survival outcomes(P<0.05),and the area under the ROC curve drawn by combining the three was 0.851(95% CI 0.811 ~ 0.891,P < 0.05). Conclusion There was a good correlation between HMGB1 and GRACE score. HMGB1 is a good predictor of clinical outcomes in the patients with acute coronary syndromes undergoing elective PCI treatment.