Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.
Atherosclerosis. 2012 Apr;221(2):490-5. doi: 10.1016/j.atherosclerosis.2012.01.040. Epub 2012 Feb 1.
High-mobility group box 1 (HMGB1) is a damage-associated molecular pattern molecule, which suggests a potential role of this protein in the pathophysiology of acute coronary syndrome (ACS). Circulating HMGB1 has been shown to be independently associated with cardiac mortality in ST-segment elevation myocardial infarction. However, its prognostic value remains unclear in unstable angina and non-ST-segment elevation myocardial infarction (UA/NSTEMI).
HMGB1, high-sensitivity C-reactive protein (hsCRP), cardiac troponin I and B-type natriuretic peptide concentrations were measured on admission in 258 consecutive patients (mean age of 67 years) hospitalized for UA/NSTEMI within 24h (mean, 7.4h) of the onset of chest symptoms.
A total of 38 (14.7%) cardiovascular deaths, including 10 in-hospital deaths, occurred during a median follow-up period of 49 months after admission. In a stepwise Cox regression analysis including 19 well-known clinical predictors of ACS, HMGB1 [relative risk (RR) 3.24 per 10-fold increment; P = 0.0003], cardiac troponin I (RR 1.83 per 10-fold increment, P = 0.0007), Killip class>1 (RR 4.67, P = 0.0001) and age (RR 1.05 per 1-year increment, P = 0.03), but not hsCRP, were independently associated with cardiovascular mortality. In-hospital and cardiovascular mortality rates were higher in patients with increased HMGB1 (≥ 2.4 ng/mL of median value) than those without increased HMGB1 (6.3% vs. 1.5%, P = 0.04; and 23% vs. 6.9%, P = 0.0003).
Circulating concentration of HMGB1 on admission may be a potential and independent predictor of cardiovascular mortality in patients hospitalized for UA/NSTEMI within 24h of onset.
高迁移率族蛋白 B1（HMGB1）是一种损伤相关分子模式分子，这表明该蛋白在急性冠状动脉综合征（ACS）的病理生理学中可能发挥作用。已有研究表明，循环 HMGB1 与 ST 段抬高型心肌梗死患者的心脏死亡率独立相关。然而，其在不稳定型心绞痛和非 ST 段抬高型心肌梗死（UA/NSTEMI）患者中的预后价值尚不清楚。
连续入组 258 例 UA/NSTEMI 患者，于胸痛发作后 24 小时内（平均 7.4 小时）入院，检测其入院时的 HMGB1、高敏 C 反应蛋白（hsCRP）、心肌肌钙蛋白 I 和 B 型利钠肽浓度。
中位随访 49 个月期间，共发生 38 例（14.7%）心血管死亡事件，包括 10 例院内死亡。在包括 19 个 ACS 已知临床预测因素的逐步 Cox 回归分析中，HMGB1 [每增加 10 倍的相对风险（RR）为 3.24；P = 0.0003]、心肌肌钙蛋白 I（RR 1.83 每增加 10 倍，P = 0.0007）、Killip 分级>1（RR 4.67，P = 0.0001）和年龄（RR 每增加 1 岁为 1.05，P = 0.03），而不是 hsCRP，与心血管死亡率独立相关。HMGB1 升高（≥中位值的 2.4 倍）患者的院内和心血管死亡率均高于 HMGB1 不升高患者（6.3%比 1.5%，P = 0.04；23%比 6.9%，P = 0.0003）。
发病后 24 小时内入院的 UA/NSTEMI 患者，入院时循环 HMGB1 浓度可能是心血管死亡率的一个潜在独立预测因素。
