高迁移率族蛋白B1和Toll样受体4轴与老年高血压脑出血血肿体积及预后的关系  

Relationship of HMGB1/TLR4 axis with hematoma volume and outcome in elderly hypertensive intracerebral hemorrhage patients

作　　者：杜磊[1] 徐军[1] 杨瑞[2] Du Lei;Xu Jun;Yang Rui(Department of Neurosurgery,Ningxia Medical University General Hospital,Yinchuan 750004,Ningxia Hui Autonomous Region,China)

机构地区：[1]宁夏医科大学总医院神经外科,银川750004 [2]宁夏医科大学总医院血液科,银川750004

出　　处：《中华老年心脑血管病杂志》2021年第10期1050-1054,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：宁夏回族自治区重点研发计划项目(2019BEG03059)。

摘　　要：目的研究血清高迁移率族蛋白B 1(HMGB1)、Toll样受体4(TLR4)轴及其下游炎性因子与老年高血压脑出血血肿体积及预后的关系。方法选取2017年6月~2019年9月于我院收治的240例老年高血压脑出血患者作为研究组,选取同时段于我院接受治疗的100例单纯性高血压患者作为对照组。行头颅CT检测血肿体积,采用酶联免疫吸附法检测受试者血清HMGB1、TLR4、髓样分化因子(MyD88)、NF-κB、TNF-α表达水平。比较2组受试者基线资料以及HMGB1、TLR4轴及其下游炎性因子水平。采用Pearson相关性分析患者血清HMGB1、TLR4轴及其下游炎性因子水平与血肿体积的相关性。患者均随访1年,共5例失访。根据预后情况分为预后良好165例、预后不良70例,比较2组患者HMGB1、TLR4轴及其下游炎性因子水平,用ROC曲线分析血清HMGB1、TLR4轴及其下游炎性因子对预后的预测价值。结果对照组血清HMGB1、TLR4、MyD88、NF-κB、TNF-α水平均显著低于研究组,差异有统计学意义(P<0.01)。Pearson相关性分析显示,血清HMGB1、TLR4、MyD88、NF-κB、TNF-α水平与血肿体积均呈正相关(r值分别为0.452、0.496、0.485、0.508、0.468,P<0.05)。随访1年,70.21%患者预后良好,29.79%患者预后不良。预后不良患者的血清HMGB1、TLR4、MyD88、NF-κB、TNF-α水平均明显高于预后良好患者(P<0.01)。ROC曲线分析显示,HMGB1、TLR4、MyD88、NF-κB、TNF-α预测预后不良的曲线下面积分别为0.821(95%CI:0.762~0.880)、0.799(95%CI:0.737~0.861)、0.812(95%CI:0.754~0.869)、0.822(95%CI:0.762~0.882)、0.773(95%CI:0.705~0.840)。结论老年高血压脑出血患者的HMGB1、TLR4轴及下游炎性因子均处于高表达状态,表达水平与血肿体积呈正相关,具有较高的预后预测价值。Objective To study the relationship of high mobility group protein B 1(HMGB1)and TLR4 axis and its downstream inflammatory factors with hematoma volume and outcome in elderly hypertensive intracerebral hemorrhage patients.Methods Two hundred and forty elderly hypertensive intracerebral hemorrhage patients admitted to our hospital from June 2017 to September 2019 served as a study group and 100 simple hypertensive patients admitted to our hospital during the same period served as a control group.Their hematoma volume and serum levels of HMGB1,TLR4,MyD88,NF-κβand TNF-αwere measured by head CT and ELISA respectively.The relationship of HMGB1/TLR4 axis and serum levels of its downstream inflammatory factors with hematoma volume was analyzed by Pearson correlation analysis.The patients in study group were followed up for 1 year(with 5 lost their follow-up)and were further divided into good outcome group(n=165)and poor poor outcome group(n=70).The HMGB1/TLR4 axis and serum levels of its downstream inflammatory factors were compared between the two groups.The value of HMGB1/TLR4 axis and serum levels of its downstream inflammatory factors for predicting the outcome in elderly hypertensive intracerebral hemorrhage patients was analyzed by ROC curve analysis.Results The serum levels of HMGB1,TLR4,MyD88,NF-κB and TNF-αwere significantly lower in control group than in study group(P<0.01).Pearson correlation analysis showed that the serum levels of HMGB1,TLR4,MyD88,NF-κB and TNF-αwere positively related with the hematoma volume in elderly hypertensive intracerebral hemorrhage patients(r=0.452,0.496,0.485,0.508,0.468,P<0.05).The good outcome and poor outcome accounted for 70.21%and 29.78%respectively in elderly hypertensive intracerebral hemorrhage patients after 1-year follow-up.The serum levels of HMGB1,TLR4,MyD88,NF-κβand TNF-αwere significantly higher in elderly hypertensive intracerebral hemorrhage patients with a poor outcome than in those with a good outcome(P<0.01).ROC curve analysis showed that the AUC of H

关 键 词：高迁移率族蛋白质类 TOLL样受体4 颅内出血 高血压性 血肿 髓样分化因子88 NF-κB 

分 类 号：R544.1[医药卫生—心血管疾病] R743.34[医药卫生—内科学]