急性胰腺炎患者血清高迁移率族蛋白B1水平的变化及意义

Serum levels and roles of high mobility group box-1 protein in patients with acute pancreatitis

目的 检测急性胰腺炎（AP）患者血清高迁移率族蛋白B1（high mobility groupbox．1protein，HMGB1）的水平变化，探讨HMGB1在AP发生发展中的作用。方法以33例重症急性胰腺炎（SAP）、38例轻症急性胰腺炎（MAP）以及28例健康体检者为研究对象，在发病72h内收集血标本，采用ELISA法检测血清HMGB1水平，分析其与患者性别，年龄，病因，发病时间，Ranson评分，BahhazarCT评分，血清c-反应蛋白（CRP）、乳酸脱氢酶（LDH）、肌酐、总胆红素等指标，局部和（或）全身并发症的关系。结果健康对照组、MAP组、SAP组血清HMGB1水平分别为（1．82±0．64）μg／L、（6．13±5．80）μg／L、（11．48±6．94）μg／L，SAP组显著高于MAP组，MAP组又显著高于健康对照组（P值均〈0．05）。在发病24h内患者血清HMGBI水平开始增高，48h内达峰值，后开始下降，至72h仍维持在高于正常值水平。血清HMGBI水平与患者性别、年龄、病因无关；与Ranson评分、BalthazarCT评分、CRP、LDH、血肌酐值呈正相关关系。有局部和（或）全身并发症患者血清HMGB1水平高于无并发症者，但差异不显著。结论HMGB1是一种晚期炎症介质，与AP病情的严重程度相关，并可能参与了SAP时肾功能不全的发生。

Objectives To determine the serum levels of high mobility group box-1 protein （ HMGB1 ） in patients with acute pancreatitis （AP） and to investigate the contributions of HMGB1 in the pathogenesis of AP. Methods The serum HMGB1 concentrations were determined by enzyme-linked immunosorbent assay in 33 patients with severe acute pancreatitis （SAP）, 38 patients with mild acute pancreatitis （MAP） and 28 healthy controls at the time of admission within 72 h after the onset. THe relationships between the serum HMGB1 levels and sex, age, etiology, disease onset, Ranson score, Balthazar CT score, C-reactive protein, lactate dehydrogenase and serum creatinine, total bilirubin levels, local and systematic complications were analized. Results The serum HMGB1 levels in healthy control group, MAP group and SAP group were （ 1.82 ±0.64） μg/L, （ 6.13 ± 5.80） μg/L and （ 11.48± 6.94） μg/L, respectively. The mean value of serum HMGB1 level in MAP group was significantly higher than that in healthy group （ P 〈 0.05 ）, while it was significantly lower than that in SAP group （P 〈0.05）. Within 24 h after disease onset, the serum levels of HMGB1 began to increase, and reached the peak at 48 h, then decreased and remained higher than normal value at 72 h. There were no remarkable relationships between the serum HMGB1 levels and sex, age, etiology, but it was positively correlated with Ranson score, Balthazar CT score, C-reactive protein, lactate dehydrogenasc and serum ereatinine. The serum levels of HMGB 1 in patients with local and / or systematic complications were higher than those in patients without complications, but the difference was not statistically significant. Conclusions HMGB1 is a late inflammation mediator and serum HMGB1 levels were correlated with the severity of AP. HMGBI may participate in the development of acute renal insufficiency during SAP.