右束支传导阻滞联合血清HMGB1在COPD患者并发肺心病监测中的临床价值

doi:10.11958/20253397

天津医药 ›› 2026, Vol. 54 ›› Issue (8): 842-847.doi: 10.11958/20253397

右束支传导阻滞联合血清HMGB1在COPD患者并发肺心病监测中的临床价值

张晶¹(), 桂晓玲², 李金鹏³, 陈新¹^,^△()

¹ 河南省第三人民医院功能检查科（邮编450052）
² 河南省第三人民医院呼吸内科（邮编450052）
³ 郑州大学第三附属医院检验科

收稿日期:2025-11-23 修回日期:2026-04-12 出版日期:2026-08-15 发布日期:2026-08-07
通讯作者: △E-mail：xylchx@126.com
作者简介:张晶（1987），女，主治医师，主要从事心电图诊断方面研究。E-mail：1119285098@qq.com
基金资助:
河南省医学科技攻关计划联合共建项目(LHGJ20220255)

The clinical value of right bundle branch block combined with serum high-mobility group box 1 for monitoring of cor pulmonale in patients with chronic obstructive pulmonary disease

ZHANG Jing¹(), GUI Xiaoling², LI Jinpeng³, CHEN Xin¹^,^△()

¹ Department of Functional Examination, Henan Provincial Third People's Hospital, Zhengzhou 450052, China
² Department of Respiratory Medicine, Henan Provincial Third People's Hospital, Zhengzhou 450052, China
³ Department of Laboratory Medicine, the Third Affiliated Hospital of Zhengzhou University

Received:2025-11-23 Revised:2026-04-12 Published:2026-08-15 Online:2026-08-07
Contact: △E-mail: xylchx@126.com

张晶, 桂晓玲, 李金鹏, 陈新. 右束支传导阻滞联合血清HMGB1在COPD患者并发肺心病监测中的临床价值[J]. 天津医药, 2026, 54(8): 842-847.

ZHANG Jing, GUI Xiaoling, LI Jinpeng, CHEN Xin. The clinical value of right bundle branch block combined with serum high-mobility group box 1 for monitoring of cor pulmonale in patients with chronic obstructive pulmonary disease[J]. Tianjin Medical Journal, 2026, 54(8): 842-847.

摘要/Abstract

摘要：

目的探讨心电图右束支传导阻滞（RBBB）联合血清高迁移率族蛋白B1（HMGB1）在慢性阻塞性肺疾病（COPD）患者并发肺心病中的临床应用价值。方法纳入138例COPD患者，随访12个月，根据是否发生肺心病分为肺心病组（42例）和无肺心病组（96例）。比较2组基线特征、RBBB阳性率和HMGB1水平差异，采用Cox回归分析RBBB、HMGB1与肺心病发病的关联强度，受试者工作特征（ROC）曲线评价二者的预测效能，Kaplan-Meier法分析COPD患者肺心病的进展情况。结果肺心病组RBBB阳性率（59.5% vs. 22.9%）及血清HMGB1水平[（8.92±2.61）μg/L vs.（5.38±1.77）μg/L]高于无肺心病组（均P<0.01）。RBBB联合HMGB1预测肺心病发病的曲线下面积（AUC）为0.915（95%CI：0.856~0.962），高于单一指标预测。多因素Cox回归结果显示，在校正多个混杂因素后，RBBB阳性（HR=2.002，95%CI：1.289~3.107，P<0.001）和HMGB1升高（HR=1.177，95%CI：1.063~1.303，P=0.002）仍是COPD患者肺心病发病的独立危险因素。Kaplan-Meier分析显示，高风险组（RBBB阳性且HMGB1≥6.85 μg/L）患者1年并发肺心病发生率为63.64%，显著高于低风险组（RBBB阴性且HMGB1<6.85 μg/L）患者（8.82%，Log-rank χ²=50.465，P<0.001）。结论 RBBB联合血清HMGB1有助于评估COPD患者并发肺心病的风险，可识别高危人群。

关键词: 肺疾病, 慢性阻塞性, 肺心病, 束支传导阻滞, HMGB1蛋白质, 预后

Abstract:

Objective To investigate the clinical value of electrocardiographic right bundle branch block (RBBB) combined with serum high-mobility group box 1 (HMGB1) in monitoring the development of cor pulmonale in patients with chronic obstructive pulmonary disease (COPD). Methods A total of 138 COPD patients were enrolled and followed up for 12 months. Patients were divided into the cor pulmonale group (n=42) and the non-cor pulmonale group (n=96) based on whether cor pulmonale occurred during follow-up. Baseline characteristics, RBBB positivity rates and serum HMGB1 levels were compared between the two groups. Multivariate Cox regression was used to assess the association between RBBB, HMGB1 and cor pulmonale development. Receiver operating characteristic (ROC) curves were constructed to evaluate the predictive performance of each indicator, and the Kaplan-Meier method was applied to analyze the progression of cor pulmonale in COPD patients. Results The positive rate of RBBB (59.5% vs. 22.9%) and serum HMGB1 levels [(8.92±2.61) μg/L vs. (5.38±1.77) μg/L)] were significantly higher in the cor pulmonale group than those in the non-cor pulmonale group ( P<0.01). The area under the curve (AUC) for RBBB combined with HMGB1 in predicting cor pulmonale was 0.915 (95%CI: 0.856-0.962), which was superior to either marker alone. Multivariate Cox regression analysis demonstrated that after adjusting for multiple confounding factors, RBBB positivity (HR=2.002, 95%CI: 1.289-3.107, P<0.001) and elevated HMGB1 (HR=1.177, 95%CI: 1.063-1.303, P=0.002) remained independent risk factors for cor pulmonale in COPD patients. Kaplan-Meier analysis revealed that the 1-year incidence of cor pulmonale was 63.64% in the high-risk group (RBBB-positive and HMGB1 ≥6.85 μg/L), which was significantly higher than that in the low-risk group (RBBB-negative and HMGB1<6.85 μg/L) (8.82%, Log-rank χ²=50.465, P<0.001). Conclusion The combination of RBBB and serum HMGB1 provides valuable clinical utility in assessing the risk of cor pulmonale in COPD patients and enables effective identification of high-risk individuals.

Key words: pulmonary disease, chronic obstructive, pulmonary heart disease, bundle-branch block, HMGB1 protein, prognosis

中图分类号:

R563

图/表 7

参考文献 22

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组别		n		年龄/岁		男性			BMI/（kg/m²）
无肺心病组		96		67.1±8.8		66（68.8）			23.8±3.6
肺心病组		42		71.2±7.9		32（76.2）			23.1±3.4
t或χ²				2.789^＊＊		0.786			1.052
组别	GOLD 3—4级				FEV1%pred/ %			FEV1/FVC/ %			6MWD/ m
无肺心病组	50（52.1）				56.4±16.2			59.6±10.5			362±82
肺心病组	33（78.6）				42.6±13.8			51.3±9.8			298±76
χ²或t	8.614^＊＊				4.892^＊＊			4.376^＊＊			4.331^＊＊
组别			mMRC评分				高血压			糖尿病
无肺心病组			2.1±0.8				39（40.6）			20（20.8）
肺心病组			2.8±0.9				19（45.2）			11（26.2）
t或χ²			4.512^＊＊				0.249			0.482

组别		n		年龄/岁		男性			BMI/（kg/m²）
无肺心病组		96		67.1±8.8		66（68.8）			23.8±3.6
肺心病组		42		71.2±7.9		32（76.2）			23.1±3.4
t或χ²				2.789^＊＊		0.786			1.052
组别	GOLD 3—4级				FEV1%pred/ %			FEV1/FVC/ %			6MWD/ m
无肺心病组	50（52.1）				56.4±16.2			59.6±10.5			362±82
肺心病组	33（78.6）				42.6±13.8			51.3±9.8			298±76
χ²或t	8.614^＊＊				4.892^＊＊			4.376^＊＊			4.331^＊＊
组别			mMRC评分				高血压			糖尿病
无肺心病组			2.1±0.8				39（40.6）			20（20.8）
肺心病组			2.8±0.9				19（45.2）			11（26.2）
t或χ²			4.512^＊＊				0.249			0.482

组别	n	RBBB阳性	HMGB1/（μg/L）	WBC/（×10⁹/L）
无肺心病组	96	22（22.9）	5.38±1.77	8.1±2.1
肺心病组	42	25（59.5）	8.92±2.61	8.7±2.4
χ2或t		17.392^＊＊	9.412^＊＊	1.462
组别	NLR	hs-CRP/ （mg/L）	NT-proBNP/（ng/L）	D-二聚体/ （mg/L）
无肺心病组	3.7±1.6	5.9（2.7，11.6）	439（187，698）	0.62（0.31，0.98）
肺心病组	5.9±2.3	10.6（4.9，22.1）	696（398，1 985）	1.02（0.58，1.39）
t或Z	6.428^＊＊	6.713^＊＊	8.157^＊＊	5.829^＊＊
组别	p（O₂）/mmHg		p（CO₂）/mmHg		血pH
无肺心病组	68.7±8.6		44.3±6.5		7.40±0.04
肺心病组	58.4±9.2		52.6±8.7		7.38±0.05
t	6.314^＊＊		6.108^＊＊		1.892

组别	n	RBBB阳性	HMGB1/（μg/L）	WBC/（×10⁹/L）
无肺心病组	96	22（22.9）	5.38±1.77	8.1±2.1
肺心病组	42	25（59.5）	8.92±2.61	8.7±2.4
χ2或t		17.392^＊＊	9.412^＊＊	1.462
组别	NLR	hs-CRP/ （mg/L）	NT-proBNP/（ng/L）	D-二聚体/ （mg/L）
无肺心病组	3.7±1.6	5.9（2.7，11.6）	439（187，698）	0.62（0.31，0.98）
肺心病组	5.9±2.3	10.6（4.9，22.1）	696（398，1 985）	1.02（0.58，1.39）
t或Z	6.428^＊＊	6.713^＊＊	8.157^＊＊	5.829^＊＊
组别	p（O₂）/mmHg		p（CO₂）/mmHg		血pH
无肺心病组	68.7±8.6		44.3±6.5		7.40±0.04
肺心病组	58.4±9.2		52.6±8.7		7.38±0.05
t	6.314^＊＊		6.108^＊＊		1.892

变量	AUC（95%CI）	截断值	敏感度/%	特异度/ %	约登指数	Z^＃
RBBB	0.683（0.598~0.760）	阳性	59.50	77.10	0.366	3.826^＊
HMGB1	0.830（0.757~0.889）	6.85 μg/L	85.70	78.10	0.638	3.214^＊
RBBB+ HMGB1	0.915（0.856~0.962）	-	90.50	87.50	0.780

右束支传导阻滞联合血清HMGB1在COPD患者并发肺心病监测中的临床价值

The clinical value of right bundle branch block combined with serum high-mobility group box 1 for monitoring of cor pulmonale in patients with chronic obstructive pulmonary disease

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变量	β	SE	Wald χ²	P	HR	HR 95%CI
模型1 RBBB阳性	0.930	0.211	19.415	<0.001	2.534	1.672~3.840
HMGB1	0.221	0.047	22.068	<0.001	1.248	1.138~1.370
模型2
RBBB阳性	0.909	0.213	18.196	<0.001	2.481	1.634~3.767
HMGB1	0.208	0.048	18.757	<0.001	1.231	1.120~1.353
模型3
RBBB阳性	0.694	0.224	9.588	<0.001	2.002	1.289~3.107
HMGB1	0.163	0.052	9.838	0.002	1.177	1.063~1.303

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