The Diagnostic Significance Of HMGB1to Early Newborns With Persistent Pulmonary Hypertension

Objective:The pathogenesis between persistent pulmonary hypertension of the newborn (PPHN) and idiopathic pulmonary hypertension in adults are not exactly the same. High mobility group box-1(HMGB1) is one of the cytokines in inflammatory response. The literature reports the level of serum HMGB1was significantly increased in adult patients with idiopathic pulmonary hypertension, but there are no reports about the relationship between HMGB1and PPHN. This study was to investigate the diagnostic significance of HMGB1to early newborns with PPHN.Methods:There were totally80newborns with age less than1week. They were divided into3groups:normal term with cordblood (n=30, normal cordblood group), late preterm group (n=30), and PPHN group (n=20)(patients were matched by delivery way, gestational age, gender, birth weight, and timepoint of blood sampling by1:1.5ratio). All PPHN infants met the diagnostic criteria in the fourth edition of Practice of Neonatology. Milrinone and conventional treatments were given to PPHN infants. Blood samples were taken before the treatment started, at24h of the treatment, and at24h after milrinone was stoppid. The main parameters were HMGB1, tumor necrosis factor-alpha (TNF-a), and interleukin-6(IL-6) assessed by Enzyme-linked immunosorbent adsorption experiment (ELISA). Other commom laboratory examinations included arterial blood gas analysis, c-reactive protein (CRP), procalcitonin (PCT) and blood culture.Results:1. HMGB1level of normal control, late preterm, and PPHN groups were (2.85±1.21),(8.74±2.60), and (25.70±4.12)ng/ml, respectively. There were significant difference among three groups after variance analysis (F=52.354, P<0.05).2. HMGB1level of PPHN patients at24h of the treatment and at24h after milrinone was stopped were (14.80±2.24) and (4.64±1.06)ng/ml, respectively. There was significant difference after individual t-test (t=18.306, P<0.05).3. Before any treatment started, serum HMGB1level was positively correlated with TNF-a and IL-6(r=0.526and0.613, P<0.05) and negatively corrected with arterial oxygen pressure and arterial oxygen saturation(r=-0.957and-0.897, P<0.05). There were no correlations between HMGB1and CRP (r=0.232, P>0.05).Conclusions:The level of serum HMGB1was significantly elevated in early newborns with PPHN. And with the ease of illness, the level of serum HMGB1gradually declines. Dynamic monitoring of serum HMGB1may help the clinical diagnosis and assessment of PPHN.