【摘要】 目的 分析血清高迁移率族蛋白B1(high mobility group box 1,HMGB1)及超声心动图指标与慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)合并肺动脉高压(pulmonary hypertension, PH)患者右心功能的关系。方法 回顾性收集2020年1月—2023年1月在甘肃省人民医院接受治疗的COPD患者108例的临床资料。根据患者是否合并PH,分为PH组(n=41)和非PH组(n=67)。收集患者的基本资料，并测定其血清中HMGB1水平。通过彩色多普勒超声心动图检查患者右心结构指标，并比较2组平均肺动脉压和右心功能[右心室射血分数(right ventricular ejection fraction, RVEF)、心脏超声A峰和E峰流速比值(ratio of peak early diastolic filling velocity to peak late diastolic filling velocity, E/A)、右心室心肌做功指数(right ventricular myocardial performance index, RMPI)]。利用Logistic多因素分析评估COPD并发PH的风险因素，并利用Pearson分析HMGB1与右心结构及功能的关系。结果 PH组血清HMGB1水平为(5.79±1.12)μg/L,高于非PH组，PH组的平均肺动脉压、RMPI分别为(48.27±4.42)mmHg、(0.66±0.14),均比非PH组增加，PH组的右心房结构指标、RVEF和E/A低于非PH组(P<0.05)。Logistic分析显示HMGB1水平、右心房结构、RVEF、E/A和RMPI都会影响PH的发生，且HMGB1水平与平均肺动脉压、RMPI呈正相关(r=0.492,P<0.001;r=0.430,P<0.001),但与RVEF、E/A呈负相关(r=-0.460,P<0.001;r=-0.325,P<0.001)。结论 COPD合并PH患者表现出更高的血清HMGB1水平和显著的右心结构及功能异常，提示PH可能加剧COPD患者的心脏负担。更多还原

【Abstract】 Objective To analyze the relationship of serum high mobility group box 1(HMGB1) levels and echocardiographic indicators with right heart function in patients with chronic obstructive pulmonary disease(COPD) complicated with pulmonary hypertension(PH). Methods Clinical data from 108 COPD patients who received treatment at Gansu Provincial Hospital from January 2020 to January 2023 were retrospectively collected. According to whether the patient had complicated PH, they were divided into PH group(n=41) and non-PH group(n=67). The basic data of patients were collected and their serum levels of HMGB1 were measured. Color Doppler echocardiography was performed to examine the structural indicators of the patient’s right heart, and the average pulmonary artery pressure and right heart function [right ventricular ejection fraction(RVEF), ratio of peak early diastolic filling velocity to peak late diastolic filling velocity(E/A), right ventricular myocardial performance index(RMPI)] were compared between two groups. Multivariate logistic analysis was used to assess the risk factors for COPD complicated with PH, and Pearson analysis was performed to analyze the relationship between HMGB1, right heart structure, and function. Results The serum HMGB1 levels in PH group was(5.79±1.12) μg/L, which was higher than that in non-PH groups. The mean pulmonary arterial pressure and RMPI in the PH group were(48.27±4.42) mmHg and(0.66±0.14) respectively, both of which were higher than those in the non-PH group. The structural indicators of the right atrium, RVEF, and E/A ratio in the PH group were lower than those in the non-PH group(P<0.05). Logistic analysis showed that levels of HMGB1, right atrium structure, RVEF, E/A, and RMPI all affected the occurrence of PH, and the level of HMGB1 was positively correlated with mean pulmonary arterial pressure and RMPI(r=0.492, P<0.001; r=0.430, P<0.001), but negatively correlated with RVEF and E/A(r=-0.460, P<0.001; r=-0.325, P<0.001). Conclusion Patients with COPD complicated with PH exhibit higher serum HMGB1 levels and significant abnormalities in right heart structure and function, suggesting that pulmonary hypertension may exacerbate cardiac burden in patients with COPD.更多还原