血清HMGB1与原发性高血压患者早期肾损伤的临床关系研究-东南大学学报医学版

血清HMGB1与原发性高血压患者早期肾损伤的临床关系研究

单位：衡水市人民医院心内科, 河北衡水 053000

关键词：原发性高血压高迁移率蛋白B1 早期肾损伤白细胞介素-6 肿瘤坏死因子-α

分类号：R544.11; R692

出版年·卷·期（页码）：2023·42·第六期（926-931）

摘要：

目的:观察原发性高血压早期肾损伤患者血清高迁移率蛋白B1(HMGB1)水平改变以及其水平与早期肾损伤的相关性。方法:选择2020年10月至2022年10月在衡水市人民医院门诊就诊的原发性高血压患者210例,根据尿微量白蛋白/尿肌酐值(UACR)分为早期肾损伤组(UACR 30~300 mg·g^-1,92例)和对照组(UACR<30 mg·g^-1,118例)。比较两组患者血清HMGB1、白细胞介素-6(IL-6)、和肿瘤坏死因子-α(TNF-α)水平改变。观察血清HMGB1水平与IL-6、TNF-α水平相关性。多因素Logistic回归分析影响原发性高血压早期肾损伤发生的相关因素。应用受试者工作特征(ROC)曲线选取血清HMGB1诊断原发性高血压早期肾损伤的最佳截断值,计算其敏感性、特异性。结果:早期肾损伤组血清HMGB1、IL-6水平高于对照组[(10.44±3.62)vs(6.87±1.89) ng·mL^-1,(47.08±15.19)vs(31.25±6.09) pg·mL^-1,均P<0.01],血清TNF-α水平两组之间差异无统计学意义[(28.88±8.14)vs(27.79±9.15) pg·mL^-1,P>0.05]。早期肾损伤组血清HMGB1水平与IL-6水平具有相关性(r=0.650,P<0.01),与TNF-α水平相关性不显著(r=0.078,P>0.05)。多元Logistic回归分析显示,血清HMGB1、IL-6水平升高是原发性高血压早期肾损伤发生的危险因素(P<0.01)。HMGB1诊断原发性高血压早期肾损伤的最佳截断值为5.87 ng·mL^-1,曲线下面积0.901(95%CI:0.854~0.947),其敏感性为98.7%,特异性65.9%。结论:原发性高血压早期肾损伤患者血清HMGB1水平升高,其水平超过5.87 ng·mL^-1对原发性高血压早期肾损伤有一定预测价值,HMGB1可能通过炎症反应影响早期肾损伤的发生。

Objective: To observe the changes of serum high-mobility group box-1 protein(HMGB1) level and its correlation with early renal injury in patients with essential hypertension. Methods: A total of 210 patients with essential hypertension who were treated in the outpatient department of Hengshui People's Hospital from October 2020 to October 2022 were selected and divided into early renal injury group[the urinary microalbumin/urinary creatinine ratio(UACR)30-300 mg·g^-1,92cases] and control group(UACR<30 mg·g^-1,118cases) according to UACR. Serum levels of HMGB1, interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were compared between the two groups.The correlation between serum HMGB1 level and IL-6, TNF-α level was observed. Multivariate Logistic regression analysis was used to analyze the related factors affecting early renal injury in patients with essential hypertension.Receiver operating characteristic(ROC) curve was used to select the best threshold of serum HMGB1 in the diagnosis of early renal injury in essential hypertension patients, and its sensitivity and specificity were calculated. Results: Serum levels of HMGB1 and IL-6 in early renal injury group were higher than those in control group[(10.44±3.62)vs(6.87±1.89)ng·mL^-1,(47.08±15.19)vs(31.25±6.09)pg·mL^-1,all P<0.01].There was no significant difference in TNF-α levels between the two groups[(28.88±8.14)vs(27.79±9.15)pg·mL^-1,P>0.05].In early renal injury group, serum HMGB1 level was correlated with IL-6 level(r=0.650,P<0.01), but not significant with TNF-α(r=0.078,P>0.05). Multiple Logistic regression analysis showed that elevated serum levels of HMGB1 and IL-6 were risk factors for early renal injury in essential hypertension(P<0.01).The best threshold of HMGB1 in the diagnosis of early renal injury in patients with essential hypertension was 5.87 ng·mL^-1, area under the curve was 0.901(95%CI:0.854-0.947), with sensitivity of 98.7% and specificity of 65.9%. Conclusion: Serum HMGB1 level increased in patients with early renal injury in essential hypertension,the level of HMGB1 more than 5.87 ng·mL^-1 has certain predictive value for early renal injury in essential hypertension. HMGB1 may affect the occurrence of early renal injury through inflammatory response.

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