转化医学杂志

目的 探究急性心肌梗死（AMI）合并肺部感染患者外周血单个核细胞（PBMC）上高迁移率族蛋白B1/Toll样受体4(HMGB1/TLR4)信号通路表达及其检测价值。方法 选取2023年1月至2025年1月空军军医大学第一附属医院收治的173例AMI患者为研究对象，根据住院期间肺部感染情况分为感染组（104例）及非感染组（69例）。对患者进行病原菌培养，并将感染组患者分为重症组（26例）及轻症组（78例）。比较不同感染程度患者及对照组PBMC上HMGB1/TLR4信号通路相关蛋白表达水平，采用Spearman检验分析HMGB1/TLR4信号通路相关蛋白表达与肺部感染严重程度的相关性，采用受试者工作特征（ROC）曲线分析HMGB1/TLR4信号通路相关蛋白表达对AMI合并肺部感染患者病情严重程度的评估价值，采用Logistic回归分析HMGB1/TLR4信号通路相关蛋白表达与肺部感染加重的关系。结果 重症组及轻症组HMGB1、核因子κB(NF-κB)、TLR4、髓系分化初级反应蛋白质88(MyD88)蛋白表达水平均高于非感染组（P<0.05），重症组HMGB1、NF-κB、TLR4、MyD88蛋白表达水平均明显高于轻症组（P<0.05）。AMI合并肺部感染患者PBMC上HMGB1、NF-κB、TLR4、MyD88蛋白表达水平与感染严重程度呈正相关（P<0.05）;PBMC上HMGB1、NF-κB、TLR4、MyD88蛋白表达水平联合检测评估肺部感染严重程度的曲线下面积大于各指标单独检测（P<0.05）。HMGB1≥9.11、NF-κB≥1.59、TLR4≥11.23、MyD88≥1.61是AMI合并肺部感染加重的危险因素（P<0.05）。结论 HMGB1/TLR4信号通路表达对AMI合并肺部感染程度具有评估价值。

Objective To explore the expression and detection value of the high mobility group box 1/Toll-like receptor 4(HMGB1/TLR4) signaling pathway in peripheral blood mononuclear cell(PBMC) of patients with acute myocardial infarction(AMI) and lung infection. Methods A total of 173 patients with AMI admitted to the First Affiliated Hospital of Air Force Medical University from January 2023 to January 2025 were selected as the study subjects. They were categorized into an infection group(104 cases) and a non-infection group(69 cases) based on the occurrence of pulmonary infections during hospitalization. Pathogenic culture was performed on the patients, and those in the infection group were further divided into a severe group(26 cases) and a mild group(78 cases). The expression levels of HMGB1/TLR4 signaling pathway-related proteins in PBMCs were compared among patients with different infection severities and the control group. The Spearman test was used to analyze the correlation between the expression of HMGB1/TLR4 signaling pathway-related proteins and the severity of lung infection. The receiver operating characteristic curve was applied to analyze the evaluation value of HMGB1/TLR4 signaling pathway-related protein expression for the severity of AMI patients with lung infection. Logistic regression analysis was used to examine the relationship between the expression of HMGB1/TLR4 signaling pathway-related proteins and the aggravation of lung infection. Results The protein expression levels of HMGB1, nuclear factor-κB(NF-κB), TLR4, and myeloid differentiation factor 88(MyD88) in the severe and mild groups were higher than those in the non-infection group(P<0.05). The protein expression levels of HMGB1, NF-κB, TLR4, and MyD88 in the severe group were significantly higher than those in the mild group(P<0.05). The protein expression levels of HMGB1, NF-κB, TLR4, and MyD88 in AMI patients with lung infection were positively correlated with the severity of lung infection(P<0.05). The area under the curve for the combined detection of HMGB1, NF-κB, TLR4, and MyD88 protein expression levels in PBMCs for evaluating the severity of lung infection was greater than that of each indicator alone(P<0.05). HMGB1≥9.11, NF-κB≥1.59, TLR4≥11.23, and MyD88≥1.61 were risk factors for the aggravation of lung infection in AMI patients(P<0.05). Conclusion The expression of the HMGB1/TLR4 signaling pathway has evaluation value for the severity of lung infection in AMI patients.