The Significance And Changes Of HMGB1in Process Of Acute Myocardial Ischemia Reperfusion

[Objectives]To discuss whether high mobility group box1protein(HMGB1) participate in theprocess of ischemical reperfusion injury(IRI) with patients accepted percutaneous coronaryintervention（PCI）with acute myocardial infarction (AMI), and taking effects in which bythe pathway of influencing levels of high-sensitivity C-reactive protein(hsCRP),interleukin(IL-6), as well as improving the prognosis of AMI through promoting theelevation of vascular endothelial growth factor(VEGF) level.[Methods]58cases of patients within6hours of onset during February2011and November2011in our hospital were divided into two group:41cases in AMI group under PCI (inaccordance with the diagnostic criteria of ISFC/WHO in1979for AMI) as AMI group and17cases in control group who were confirmed as healthy under coronary arteriongraphy,CAG). Each patient in both groups was respectively taken5ml of venous bloodpostoperative immediately and24,48hours after operation. Afterward, all samples wereplaced in refrigerator below80℃after centrifugal. Furthermore, other workups likecardiac troponin T(cTnT), isoenzyme of creatine kinase-MB(CK-MB),brain natriureticpeptide(BNP）,liver and kidney function test, lipid profiles and glucose were all berecorded at the day of admission.Besides,12leads electrocardiogram(ECG) wereperformed at the day of admission and postoperation. During the operation, real-timemonitoring ECG were used and reperfusion arrhythmia(RA)pattern of infarction relatedartery(IRA) after reopening were also recorded. Adverse clinical events such as heartfailure or sudden cardiac death were noted as well as results of color DopplerEchocardiography including left ventricular end diastolic diameter(LVEDD）, leftventricular end systolic diameter(LVESD) and left ventricular ejection fraction(LVEF）.After it all, levels of HMGB1、hsCRP、IL-6and VEGF were detected with ELISA test andbe compared at different points. All datas were analyzed by SPSS20.0software.[Results]1. There were no statistically significance as to the age, gender, smoking rates,highblood pressure rate,diabetes rates,lipid profile(mmol/L), creatinine（umol/L）, alaninetransaminase (mmol/L) in both groups.(p>0.05).2. RA was observed immediately after IRA in AMI group, including5cases of sinus bradycardia,5cases of sinus cardiac arrest,10cases of ventricular premature,7cases ofatrial premature,2cases of ventricular fibrillation,4cases of atrioventricular block,4casesof ventricular tachycardia and6cases of border area cardiac escape.3.Compared with control group, HMGB1levels of AMI group were significantlyhigher at different points. HMGB1levels of both groups at preparation were significantlyelevated after postoperative24hours (p<0.01), which at48hours after operation wassignificantly lower than that at24hours. There were no significant difference in bothgroups between two points of postoperative48hours and preoperation.(p>0.05).4. Levels of hsCRP at different points in AMI group were significantly higher thanthat of control group (p<0.01). HsCRP levels in both groups were significantly elevatedat postoperative24hours compared to preoperation (p<0.01),while it was significantlylower at postoperative48hours compared to24hours(P<0.01). However, hsCRP in bothtwo groups were still elevated at postoperative48hours compared to preoperative (p<0.01).5. Levels of IL-6at different points were significantly higher than control group(p<0.01). IL-6in both groups were significantly elevated at postoperative24hourscompared to preoperation (p<0.01).However,there were no significant difference betweentwo points at postoperative48hours and24hours（p>0.05）.IL-6levels were significantlyelevated at postoperative48hours compared to preoperation point (p <0.01).6. Levels of VEGF at different points were significantly higher than controlgroup(p<0.01). VEGF levels in both groups were significantly elevated atpostoperative24hours compared to preopration (p<0.01),as well as significantly lower atpostoperative48hours than which at24hours. VEGF levels in both groups were elevatedat postoperative48hours.(p <0.01).7. There were no significant differences as to the HMGB1,hsCRP and IL-6in the twogroups with p>0.05.However,HMGB1levels at different points were positively related toVEGF levels(with p>0.01).8. There was no significant difference as to HMGB1at different points and location ofmyocardial infarction.(p>0.05).9. There was no significant difference as to the echocardiographic results includingLVEDD (45.02±3.87mm VS42.53±2.76mm), LVESD (30.02±3.97mm VS26.76±2.54mm), LVEF（60.10±6.63mm VS66.41±2.35mm）,each with p>0.05.10.There were no statistical difference in AMI group as to the HMGB1 levels,LVEDD and LVEF at different points.（p>0.05）11.Results of HMGB1levels at different points were negatively correlated with BNPlevels after24hours in AMI group.（p<0.01）12.HMGB1levels at different points were significant lower in patients with abnormalBNP in AMI group.(p<0.01)13.Compared with healthy group, HMGB1at different points were significant lowerin patients with adverse clinical events such as heart failure or cardiac sudden death.（p<0.05）[Conclusions]1. HMGB1plays a part in the IRI during the operation process of PCI with AMIpatients although this process may be irrelevant to the level of inflammatory cells factorlike hsCRP and IL-6.2. HMGB1may participate in the process of repairment of myocardial infarctionthrough promoting the secretion of VEGF which consequently improve the heart function.3. Comparing with control group, elevation of inflammatory cells factor like hsCRP,IL-6, HMGB1may infer the occurrence of inflammatory response as well as systemicinflammation at some extent.4. HMGB1is an indicator for long-term prognosis for patients with MI.