标题：急性冠脉综合征患者血清HMGB1、cTnI、BNP、hs-CRP表达及其诊断价值

      作者：江文科，程卓，李锦良，张光平    广东医科大学附属第三医院(佛山市顺德龙江医院)心血管内科，广东 顺德 528318

      卷次： 2020年31卷12期

      【摘要】 目的 研究急性冠脉综合征患者血清中高迁移率族蛋白B1 (HMGB1)、心肌肌钙蛋白 I (cTnI)、B型脑钠肽(BNP)及超敏C-反应蛋白(hs-CRP)的表达水平及其临床诊断价值。方法 选择2016年1月至2018年1月广东医科大学附属第三医院心血管内科收治的80例急性冠脉综合征患者作为观察组，同时选取65例行体检的健康志愿者作为对照组。比较所有受检者的血清HMGB1、cTnI、BNP及hs-CRP水平，采用受试者工作特征曲线(ROC曲线)分析血清HMGB1、cTnI、BNP及 hs-CRP对急性冠脉综合征的诊断价值。结果 观察组患者的血清HMGB1、cTnI、BNP及hs-CRP水平分别为(7.41±3.51) ng/mL、(51.05±9.98) ng/mL、(83.57±11.91) pg/mL、(6.94±1.67) mg/L，明显高于对照组的(3.09±1.57) ng/mL、(16.74±4.21) ng/mL、(34.57±8.17) pg/mL、(2.67±0.56) mg/L，差异均有统计学意义(P<0.05)；观察组患者血清中 的HMGB1、cTnI、hs-CRP与 BNP之间存在一定的正相关性(r=0.760 3、0.826 4、0.374 9，P<0.05)；HMGB1诊断急性冠脉综合征的曲线下面积(AUC)为0.823，95%置信区间(CI)为0.753~0.893；cTnI诊断急性冠脉综合征的AUC为0.811，95%CI为0.740~0.883；BNP诊断急性冠脉综合征的AUC为0.825，95%CI为0.757~0.893；hs-CRP诊断急性冠脉综合征的AUC为 0.841，95%CI为 0.778~0.904；HMGB1+cTnI+BNP+hs-CRP联合诊断急性冠脉综合征的AUC为0.959，95%CI为0.931~0.988；HMGB1+cTnI+BNP+hs-CRP联合检测的AUC均分别明显高于HMGB1、cTnI、BNP、hs-CRP单独检测的AUC，差异均有统计学意义(Z=3.487、3.795、3.436、3.339，P<0.05)；HMGB1+cTnI+BNP+hs-CRP联合检测的准确度和特异度分别为94.35%和92.16%。结论 急性冠脉综合征患者血清中HMGB1、cTnI、BNP及hs-CRP的表达水平可作为诊断急性冠脉综合征的重要指标；通过联合检测急性冠脉综合征患者血清中HMGB1、cTnI、BNP及hs-CRP水平的高低，可从一定程度上反映病情的严重程度，具有非常重要的临床诊断价值。
      【关键词】 急性冠脉综合征；高迁移率族蛋白B1；心肌肌钙蛋白 I；B型脑钠肽；超敏C-反应蛋白；诊断价值
      【中图分类号】 R543.3 【文献标识码】 A 【文章编号】 1003—6350（2020）12—1530—04

Expression of serum HMGB1, cTnI, BNP and hs-CRP in patients with acute coronary syndrome and itsdiagnostic value.
JIANG Wen-ke, CHENG Zhuo, LI Jin-liang, ZHANG Guang-ping. Department of CardiovascularMedicine, the Third Affiliated Hospital of Guangdong Medical University (Shunde Longjiang Hospital, Foshan City), Shunde528318, Guangdong, CHINA
【Abstract】 Objective To study the expression level of high mobility group box protein B1 (HMGB1), cardiactroponin I (cTnI), type B brain natriuretic peptide (BNP) and hypersensitive C-reactive protein (hs-CRP) and its diagnos-tic value in patients with acute coronary syndrome, and provide guidance for the diagnosis and treatment of clinical acutecoronary syndrome. Methods From January 2016 to January 2018, 80 patients with acute coronary syndrome admittedto Department of Cardiovascular Medicine, the Third Affiliated Hospital of Guangdong Medical University were select-ed as the observation group, 65 healthy volunteers were selected as the control group. The levels of HMGB1, cTnI, BNPand hs-CRP in serum of all the subjects were measured and compared, and the diagnostic value of serum HMGB1, cTnI,BNP and hs-CRP in acute coronary syndrome were analyzed by ROC curve. Results The levels of HMGB1, cTnI,BNP and hs-CRP in the observation group were (7.41±3.51) ng/mL, (51.05±9.98) ng/mL, (83.57±11.91) pg/mL, (6.94±1.67) mg/L, respectively, which were significantly higher than corresponding (3.09±1.57) ng/mL, (16.74±4.21) ng/mL,(34.57 ± 8.17) pg/mL, (2.67 ± 0.56) mg/L in the control group (all P<0.05); there was a positive correlation betweenHMGB1, cTnI, hs-CRP and BNP in the serum of the observation group (r=0.760 3, 0.826 4, 0.374 9, all P<0.05); the ar-ea under the curve (AUC) for HMGB1 diagnosis of acute coronary syndrome was 0.823, and 95% confidence interval(CI) was 0.753-0.893; the AUC of cTnI diagnosis of acute coronary syndrome was 0.811, and 95% CI was 0.740-0.883;the AUC for BNP diagnosis of acute coronary syndrome was 0.825, 95% CI was 0.757-0.893; the AUC for hs-CRP diag-nosis of acute coronary syndrome was 0.841, and 95% CI was 0.778-0.904; the AUC for HMGB1+cTnI+BNP+hs-CRPcombined diagnosis of acute coronary syndrome was 0.959, and 95% CI was 0.931-0.988; the AUC of HMGB1+cTnI+BNP+hs-CRPcombined detection was significantly higher than that of HMGB1, cTnI, BNP and hs-CRP, and the differ-ence in AUC was statistically significant (Z=3.487, 3.795, 3.436, 3.339, all P<0.05); the accuracy and specificity of