Correlation of serum HMGB1 level with the severity of hepatic encephalopathy in liver cirrhosis and its diagnostic value

doi:10.3877/cma.j.issn.2095-2015.2025.03.013

Abstract

Abstract:

Objective

To explore the correlation of serum high mobility group protein B1(HMGB1) level with the severity of liver cirrhosis complicated with hepatic encephalopathy (HE) and its diagnostic value.

Methods

A total of 276 patients with liver cirrhosis admitted to Shaoyang Central Hospital from January 2021 to July 2024 were retrospectively selected, and 203 patients were finally selected as the research objects according to the inclusion and exclusion criteria.According to the presence or absence of HE, the patients were divided into HE group (n=97) and non-HE group (n=106).According to the West Haven classification criteria, the HE group was further divided into minimal hepatic encephalopathy (MHE) group (n=58) and overt hepatic encephalopathy (OHE) group (n=39).The baseline data of the patients were selected.Serum HMGB1 level was detected by enzyme-linked immunosorbent assay (ELISA).Spearman coefficient was used to analyze the correlation between serum HMGB1 level and psychometric scores of hepatic encephalopathy (PHES), Child-Pugh and model for end-stage liver disease(MELD) scores.Multivariate logistic regression model was established to analyze the influencing factors of HE in patients with liver cirrhosis.ROC curve was drawn to analyze the application value of serum HMGB1 level in the diagnosis and disease evaluation of HE.

Results

The serum level of HMGB1 in the OHE group was significantly higher than that in the MHE group and the non-HE group, and the serum level of HMGB1 in the MHE group was significantly higher than that in the non-HE group (all P<0.001).Serum HMGB1 level was positively correlated with Child-Pugh score and MELD score (r=0.510, r=0.662, all P<0.001), and negatively correlated with PHES score (r=-0.415, all P<0.001).MELD score, elevated blood ammonia, total bilirubin (TBIL) and serum HMGB1 levels were independent risk factors for HE in patients with liver cirrhosis (all P<0.05).The AUC of serum HMGB1 in the auxiliary diagnosis of HE was 0.829, the sensitivity was 83.96%, and the specificity was 69.07%.In the assessment of MHE and OHE, the AUC of serum HMGB1 was 0.845, the sensitivity was 79.49%, and the specificity was 86.21%.

Conclusion

Serum HMGB1 level is significantly increased in patients with HE, and its changes have a high application value in the diagnosis and disease evaluation of HE.

Key words: Liver cirrhosis, Hepatic encephalopathy, High mobility group protein B1, Correlation, Diagnostic value

Haizhe Li, Pan Liu, Yongbiao Zou, Chunhua Zhang, Lu Wang, Yanfang Li. Correlation of serum HMGB1 level with the severity of hepatic encephalopathy in liver cirrhosis and its diagnostic value[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2025, 15(03): 256-261.

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Figures/Tables 4

临床资料	非HE 组(n=106)	MHE 组(n=58)	OHE 组(n=39)	F/H/χ²	P
年龄(岁)	61.92±6.24	62.66±5.89	63.31±5.49	0.843	0.432
性别(男/女,例)	56/50	31/27	22/17	0.149	0.928
体重指数(kg/m², $\overset{ˉ}{x}$ ± s )	22.40±2.08	21.98±2.05	22.24±2.15	0.753	0.472
病因[例(%)]
乙型肝炎肝硬化	58(54.72)	34(58.62)	22(56.41)
酒精性肝硬化	45(42.45)	19(32.76)	15(38.46)	3.566	0.468
其他	3(2.83)	5(8.62)	2(5.13)
MELD 分数[M ( Q₁,　 Q₃ )]	6.49(4.28,12.05)	9.08(8.26,12.86)	15.75(10.12,21.14)	155.601	＜0.001
Child-Pugh 分级(A/B/C 级,例)	78/28/0	14/44/0	1/14/24	162.752	＜0.001
Child-Pugh 分数[M ( Q₁,　 Q₃ )]	6(5,9)	8(5,9)	10(6,13)	105.820	＜0.001
West Haven 分级(0/1/2 级,例)	-	58/0/0	0/22/17	97.000	＜0.001
PHES 分数[M ( Q₁,　 Q₃ )]	0(-1,2)	-5(-7,-4)	-	114.329	＜0.001
合并肝肾综合征[例(%)]	32(30.19)	28(48.28)	24(61.54)	13.144	＜0.001
合并肝硬化腹水[例(%)]	43(40.57)	30(51.72)	25(64.10)	6.712	0.035
合并电解质紊乱[例(%)]	22(20.75)	25(43.10)	20(51.28)	15.761	＜0.001
实验室指标( $\overset{ˉ}{x}$ ± s )
血钠(mmol/L)	135.65±8.95	134.79±9.02	135.09±8.47	0.189	0.828
血氨(μmol/L)	70.54±9.40	91.12±10.84^*	89.85±11.05^*	99.134	＜0.001
血红蛋白(g/L)	91.05±8.31	91.58±6.85	92.45±7.63	0.468	0.627
PT(s)	19.69±1.87	19.38±1.75	19.37±1.68	0.796	0.452
TBIL(μmol/L)	39.93±8.70	66.95±9.24^*	83.36±10.85^*#	367.360	＜0.001
DBIL(μmol/L)	25.25±6.59	34.11±7.96^*	45.15±8.77^*#	106.350	＜0.001
AST(U/L)	48.29±8.33	48.72±7.22	47.05±6.68	0.572	0.566
ALT(U/L)	46.59±9.86	46.28±10.23	46.31±8.75	0.024	0.977
TP(g/L)	62.35±6.91	61.72±7.94	59.35±8.42	2.281	0.105

临床资料	非HE 组(n=106)	MHE 组(n=58)	OHE 组(n=39)	F/H/χ²	P
年龄(岁)	61.92±6.24	62.66±5.89	63.31±5.49	0.843	0.432
性别(男/女,例)	56/50	31/27	22/17	0.149	0.928
体重指数(kg/m², $\overset{ˉ}{x}$ ± s )	22.40±2.08	21.98±2.05	22.24±2.15	0.753	0.472
病因[例(%)]
乙型肝炎肝硬化	58(54.72)	34(58.62)	22(56.41)
酒精性肝硬化	45(42.45)	19(32.76)	15(38.46)	3.566	0.468
其他	3(2.83)	5(8.62)	2(5.13)
MELD 分数[M ( Q₁,　 Q₃ )]	6.49(4.28,12.05)	9.08(8.26,12.86)	15.75(10.12,21.14)	155.601	＜0.001
Child-Pugh 分级(A/B/C 级,例)	78/28/0	14/44/0	1/14/24	162.752	＜0.001
Child-Pugh 分数[M ( Q₁,　 Q₃ )]	6(5,9)	8(5,9)	10(6,13)	105.820	＜0.001
West Haven 分级(0/1/2 级,例)	-	58/0/0	0/22/17	97.000	＜0.001
PHES 分数[M ( Q₁,　 Q₃ )]	0(-1,2)	-5(-7,-4)	-	114.329	＜0.001
合并肝肾综合征[例(%)]	32(30.19)	28(48.28)	24(61.54)	13.144	＜0.001
合并肝硬化腹水[例(%)]	43(40.57)	30(51.72)	25(64.10)	6.712	0.035
合并电解质紊乱[例(%)]	22(20.75)	25(43.10)	20(51.28)	15.761	＜0.001
实验室指标( $\overset{ˉ}{x}$ ± s )
血钠(mmol/L)	135.65±8.95	134.79±9.02	135.09±8.47	0.189	0.828
血氨(μmol/L)	70.54±9.40	91.12±10.84^*	89.85±11.05^*	99.134	＜0.001
血红蛋白(g/L)	91.05±8.31	91.58±6.85	92.45±7.63	0.468	0.627
PT(s)	19.69±1.87	19.38±1.75	19.37±1.68	0.796	0.452
TBIL(μmol/L)	39.93±8.70	66.95±9.24^*	83.36±10.85^*#	367.360	＜0.001
DBIL(μmol/L)	25.25±6.59	34.11±7.96^*	45.15±8.77^*#	106.350	＜0.001
AST(U/L)	48.29±8.33	48.72±7.22	47.05±6.68	0.572	0.566
ALT(U/L)	46.59±9.86	46.28±10.23	46.31±8.75	0.024	0.977
TP(g/L)	62.35±6.91	61.72±7.94	59.35±8.42	2.281	0.105

因素	P值	OR 值	95% CI
MELD 评分	0.007	5.574	1.586～19.595
Child-Pugh 分数	0.299	2.050	0.528～7.954
合并肝肾综合征(有=1,无=0)	0.532	2.470	0.145～42.196
合并肝硬化腹水(有=1,无=0)	0.836	1.349	0.079～23.081
合并电解质紊乱(有=1,无=0)	0.480	2.909	0.151～56.163
血氨(μmol/L)	0.049	1.138	1.000～1.295
TBIL(μmol/L)	0.009	1.364	1.081～1.721
DBIL(μmol/L)	0.368	1.156	0.843～1.585
HMGB1(μg/L)	0.045	3.553	1.027～12.292

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