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

doi:10.11958/20253397

Abstract

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

CLC Number:

R563

Figures/Tables 7

References 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