血清高迁移率族蛋白B1在重型乙型病毒性肝炎中的临床意义

The clinical significance of serum level of HMGB1 in severe hepatitis B

目的初步探讨人高迁移率族蛋白B1(HMGB1)在重型乙型肝炎中的临床意义。方法采用酶联免疫吸附法,检测70例慢性重型乙型肝炎、70例慢性乙型肝炎病毒(HBV)感染者、35例健康体检者的血清HMGB1水平,并对其中30例慢性重型乙型肝炎患者入院时、入院后第7天、第14天血清HMGB1水平进行动态检测;同时进行相关化验指标的检测,根据终末期肝病模型(model for end-stage liver disease,MELD)评分2002年标准版公式即:MELD分值=3.8×ln[胆红素(mg/dL)/18]+11.2×ln(INR)+9.6×ln[Cr(mg/dL)/88]+6.4×(病因:胆汁性或酒精性0,其他1),对重型乙型肝炎患者进行MELD评分计算。结果正常对照组、慢性HBV感染组、慢性重型乙型肝炎组患者血清HMGB1水平(μg/L)分别为:14.29±4.01、49.68±7.72、61.92±15.42,重型乙型肝炎组明显高于慢性HBV感染组及正常对照组(P<0.01),慢性HBV感染组高于正常对照组(P<0.01);重型乙型肝炎患者中存活组与死亡组血清HMGB1水平(μg/L)分别为:62.02±16.16、62.59±14.97,两者无明显差异(P>0.05);HMGB1水平与MELD评分无明显相关性(P>0.05);动态检测发现,死亡组患者入院后血清HMGB1水平持续下降,而存活组患者入院后血清HMGB1水平下降至第7天后出现再次上升趋势。结论 HMGB1可能与重型乙型肝炎的发生发展有关;血清HMGB1水平与MELD评分及患者预后未见明显相关性;动态检测血清HMGB1水平,可能对重型乙型肝炎患者预后预测有一定的意义。

Objective To explore the clinical significance of serum level of high-mobility group box 1 protein （HMGB1） in severe hepatitis B （SHB）. Methods The serum level of HMGB1 was detected by enzyme-linked immunosorbent assay （ELISA） in 70 patients with chronic SHB （CSHB）, 70 patients with chronic HBV infection and 35 healthy subjects. The serum level of HMGB1 of 30 patients with CSHB was observed dynamically at three time points, namely, on admission, the 7th and 14th day of admission. The model for end-stage liver disease （MELD） scores of 70 patients with CSHB were calculated according to the 2002 Standard Edition （ptmol/L） formula. Results The serum level of HMGBI （μg/L） in the normal controls, patients with chronic HBV infection, and patients with CSHB was 14.29 ± 4.01, 49.68 ± 7.72, and 61.92 ± 15.42, respectively. Pairwise comparisons among the three groups showed that the serum level of HMGB1 was significantly higher in CSHB patients than in patients with chronic HBV infection and the normal controls （P 〈 0. 01）; the serum level of HMGB1 was significantly higher in patients with chronic HBV infection than in the normal controls （P〈 0.01）. The serum level of HMGB1 （μg/L） was 62.02 ± 16.16 in CSHB survival subgroup and 62.59 ± 14.97 in CSHB non- survival subgroup, with no significant difference between the two （P〉0.05）. No significant correlation was foundbetween the serum level of HMGB1 and MELD scores （P〉O. 05）. In the 30 CSHB patients who were observed dynamically on admission, the 7th and 14th day of admission, the serum level of HMGB1 decreased gradually after admission in the non-survival group, but in the survival group it decreased to the lowest at the 7th day after admission and then increased gradually. Oonclusiofl Our study found that the serum level of HMGB1 significantly increased in CSHB, indicating that HMGB1 is involved in the pathogenesis and development of the disease. The serum level of HMGB1 has no obvious correlation with MELD scores or the prognosis. Dynamic monitoring of the serum level of HMGB1 may be significant in predicting the prognosis of SHB.