探讨高迁移率族蛋白B1(high mobility group box protein-l, HMGB-1)在炎症状态下致慢性肾功能衰竭(chronic renal failure, CRF)血液透析自体动静脉内瘘(native arteriovenous fistulas, AVF)患者血栓形成中的变化及其价值。

选取南通大学第二附属医院2012年6月至2015年7月期间，CRF需行自体动静脉AVF术患者160例，按AVF术后是否出现AVF血栓分为AVF无血栓通畅组(132例)和AVF血栓复通术前组(28例)，并比较分析两组间甘油三酯、总胆固醇、低密度脂蛋白、尿素氮、血清肌酐、血糖、D-二聚体水平以及促红细胞生成素水平差异。采用酶联免疫吸附试验(enzyme-linked immunosorbent assay, ELISA)检测AVF患者HMGB-1水平；分析160例CRF患者AVF手术前和当天HMGB-1水平差异。同时，比较28例AVF血栓复通术前组HMGB-1水平与从132例患者中选取的同期56例无血栓组(同期通畅组)水平差异，并分别用两组的HMGB-1数据绘制受试者工作特征曲线(receptor operated channel, ROC)，以分析评价HMGB-1诊断AVF血栓形成的诊断性能。

AVF术前无血栓通畅组患者的甘油三酯、总胆固醇、低密度脂蛋白、尿素氮、血清肌酐、血糖、D-二聚体水平以及促红细胞生成素水平与AVF血栓复通术前组比较，差异均无统计学意义(t值分别为0.100、0.740、0. 060、0.350、0.540、1.050、0.330、0.080，P均>0.05)；在160例CRF患者行AVF术前，28例血栓复通术前组的HMGB-1含量(2.41±0.66 ng/ml)与132例AVF无血栓通畅组(2.53±0.64 ng/ml)比较，差异无统计学意义(t=0.90, P>0.05)；而28例AVF血栓复通术前组的HMGB-1水平(5.43±1.58 ng/ml)明显高于56例同期通畅组(2.95±1.15 ng/ml)和CRF患者行AVF术前(2.41±0.66 ng/ml，t值分别为12.74、9.33，P均<0.001)。当以HMGB-1≥4.18 l ng/ml为临界值时，HMGB-1诊断AVF患者血栓形成的ROC曲线下面积为0.840，95%可信区间(CI)为0.736-0.944，敏感度及特异度均为85.7%。

AVF血栓形成时HMGB-1升高，其可能参与AVF血栓形成机制，可成为AVF血栓形成风险的辅助预测因子。

To investigate the changes of high mobility group box protein-l(HMGB-1) in chronic renal failure(CRF) patients with native arteriovenous fistulas (AVF) thrombosis, and to explore the relationship between inflammation and AVF thrombosis.

One hundred sixty CRF patients with AVF were divided into two groups according to whether with thrombosis after AVF operation: unobstructed group(n=132) and thrombosis group (n=28). The cases were collected from June, 2012 to July, 2015 in the second affiliated hospital of Nantong University. The comparative analysis of the level of triglyceride, total cholesterol, low density lipoprotein, urea nitrogen, serum creatinine, glucose, D-dimer, effects of erythropoietin was performed in two groups. The level of HMGB-1 was detected by ELISA. The levels of AVF preoperative HMGB-1 were detected in 160 cases of CRF patients. Before reopening, the levels of HMGB-1 in thrombosis group (n=28) were compared with the unobstructed group (n=56) which was in the same period. Analysis of HMGB-1 in the diagnosis of arteriovenous fistula thrombosis in the performance with the ROC curve.

The triglyceride, total cholesterol, low density lipoprotein, urea nitrogen, serum creatinine, glucose, D-dimer, effects of erythropoietin had not been significant different between unobstructed group and thrombosis group (t=0.100, 0.740, 0.060, 0.350, 0.540, 1.050, 0.330, 0.080; P>0.05); In preoperative AVF, there was no difference between the levels of HMGB-1 in thrombosis group (n=28, 2.41±0.66 ng/ml) and unobstructed group (n=132, 2.53±0.64 ng/ml, t=0.90, P>0.05). Before recanalization, the levels of HMGB-1 in thrombosis group (n=28, 5.43±1.58 ng/ml) were significant higher than that of unobstructed group in the same period (n=56, 2.95±1.15 ng/ml, t=12.74, P<0.001). The levels of HMGB-1 in thrombosis group before reopening (n=28, 5.43±1.58 ng/ml) were increased when compared with before AVF (n=28, 2.41±0.66 ng/ml, t=9.33, P<0.001). Using the designated cut-off points≥4.175 ng/ml, the areas under the curves of HMGB-1 for prognosis was 0.840, 95% confidence interval was 0.736-0.944, the sensitivities and specificities were both 85.7%.

The inflammatory marker of HMGB-1 increased when AVF thrombosis, which also may be an active participant. It can be used as a predictor in the development of fistula thrombosis.