高迁移率族蛋白B1和Toll样受体4轴与脓毒症患者发生ARDS的风险及其预后的关系

Association of high mobility group box B1 and Toll-like receptor 4 axis with the risk and prognosis of ARDS in sepsis patients

目的研究高迁移率族蛋白B1(HMGB1)和Toll样受体4(TLR4)轴与脓毒症患者发生急性呼吸窘迫综合征(ARDS)的风险及预后的关系。方法选择2022年6月至2023年10月期间我院收治的176例脓毒症患者,根据是否发生ARDS分为ARDS组(n=58)和非ARDS组(n=112),根据28 d生存情况评价预后。入院后24 h内采集静脉血并分离血清,检测HMGB1、TLR4、核转录因子-κB(NF-κB)和肿瘤坏死因子-α(TNF-α)的含量,比较两组患者临床资料及血清指标的差异,采用多因素Logistic回归分析脓毒症患者发生ARDS的影响因素,采用受试者工作特征曲线(ROC)分析脓毒症患者发生ARDS的诊断指标及预后预测指标。结果ARDS组年龄、C反应蛋白(CRP)、降钙素(PCT)、APACHEⅡ评分及血清HMGB1、TLR4、NF-κB、TNF-α含量均高于非ARDS组(t=3.007、4.423、7.413、8.069、16.955、9.072、4.751、8.569,P<0.05);HMGB1、TLR4、TNF-α和APACHEⅡ评分是脓毒症患者发生ARDS的影响因素(Waldχ^(2)=18.284、11.878、13.248、12.620,P<0.05);四项联合使用诊断和预后预测价值均优于单一指标。结论脓毒症ARDS患者的HMGB1及下游TLR4轴均处于过表达状态,血清HMGB1、TLR4、TNF-α和APACHEⅡ评分联用对脓毒症ARDS患者具有较好的诊断及预后评估价值。

Objective To investigate the association of high mobility group box B1(HMGB1)and Toll-like receptor 4(TLR4)axis with the risk and prognosis of acute respiratory distress syndrome(ARDS)in sepsis patients.Methods A total of 176 patients with sepsis admitted to the First Affiliated Hospital of Hebei North University from June 2022 to October 2023 were selected and divided into ARDS group(n=58)and non-ARDS group(n=112)according to whether ARDS occurred.The prognosis of ARDS patients with sepsis was evaluated according to 28 d survival status.Venous blood was collected and serum was separated within 24 h after admission,the contents of HMGB1,TLR4,nuclear factor-κB(NF-κB)and tumor necrosis factor-α(TNF-α)were detected.The differences of clinical data and serum indexes between the two groups were compared.The influencing factors of ARDS in sepsis patients were analyzed by multivariate Logistic regression.The diagnostic indexes and prognostic indexes of ARDS in sepsis patients were analyzed by receiver operating characteristic(ROC)curve.Results Age,C-reactive protein(CRP),procalcitonin(PCT),acute physiology and chronic health evaluationⅡ(APACHEⅡ)score and serum HMGB1,TLR4,NF-κB and TNF-αcontents in ARDS group were higher than those in non-ARDS group(t=3.007,4.423,7.413,8.069,16.955,9.072,4.751,8.569,P<0.05).HMGB1,TLR4,TNF-αand APACHEⅡscores were the influencing factors of ARDS in sepsis patients(Waldχ^(2)=18.284,11.878,13.248,12.620,P<0.05).The diagnostic and predictive values of the combined indexes were better than those of the single index.Conclusions Both HMGB1 and downstream TLR4 axis are overexpressed in sepsis patients with ARDS.The combination of serum HMGB1,TLR4,TNF-αand APACHEⅡscore has good diagnostic value and prognostic value for the ARDS patients with sepsis.