血浆高迁移率族蛋白1和肿瘤坏死因子-α评估严重胸部钝性伤患者并发症的比较

Prediction of post-traumatic complications in severe blunt chest trauma by comparing plasma levels of high-mobility group box 1 and tumor necrosis factor-a

目的:探讨高迁移率族蛋白1(high-mobility group box 1,HMGB1)和肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)在严重胸部钝性伤(blunt chest trauma,BCT)患者血浆中的动态变化及其评估伤后严重程度和预测伤后并发症发生风险性的临床意义。方法:自2011年3月-2011年12月共收集符合研究标准的严重BCT(简明损伤评分≥3)患者共57例,分别在伤后第1、3、5、7天采集患者外周静脉血。待标本收集齐后应用ELSIA测定血浆中HMGB1和TNF-α含量,并分析其与损伤严重程度和伤后并发症发生的相关性。结果:患者的中位年龄为(44.5±12.6)岁,中位损伤程度评分(injury severity score,ISS)评分为(18.4±6.02)分。伤后患者血浆HMGB1和TNF-α含量与损伤严重程度相关(第1天分别为:r=0.29,P=0.068和r=0.507,P=0.016;第3天:r=0.578,P<0.001和r=0.411,P=0.021;第5天:r=0.645,P<0.001和r=0.365,P=0.07;第7天:r=0.683,P<0.001和r=0.321,P=0.019)。ISS≥20的患者伤后第3、5、7天内血浆HMGB1水平要明显高于ISS<20者(P均<0.001)。通过受试者工作特征曲线分析结果显示,在伤后并发症预测方面,血浆HMGB1的敏感性要高于TNF-α,但特异性不及TNF-α(P<0.05)。结论:血浆HMGB1能够较好的评估严重BCT患者的损伤严重程度和并发症发生情况。

Objective：To observe the dynamic changes of plasma high-mobility group box 1 （HMGB1） and tumor necrosis factor-α （TNF-α） in patients with severe blunt chest trauma, to assess the severity of injury and to predict its prognostic value. Methods：A total of 57 consecutive blunt chest trauma patients with an abbreviated injury scale ≥3 from March 2011 to December 2011 were included and blood samples were taken from patients every other day from dl to d7 after admission. Plasma concentration of HMGBI and TNF-α were measured by a quantitative ELISA. Development of post-traumatic complications was observed and their relations with plasma levels of HMGB1 and TNF-α were analyzed. Results：Patients＇ median age was （44.5 ± 12.6） years and the median in- jury severity score（ISS） was （18.4 ±6.02）. Both the plasma levels of HMGB1 and TNF-α had positive correlation with ISS（dl ：r= 0.29, P=0.068 vs. r=0.507 ,P=0.016 ;d3 ： r=0.578 ,P〈0.001 vs. r=0.411 ,P=0.02;d5 ： r=0.645 ,P〈0.001 vs. r=0.365 ,P=0.07 ;d7 ： r=0.683, P〈0.001 vs. r=0.321 ,P=0.019）. There were significantly increases in mean plasma HMGBI levels on d3,5,7 in patients with ISS≥20 compared with those with ISS〈20（all P〈0.05）. Plasma levels of HMGB1 showed a higher sensitivity but less specificity than TNF-α in prediction of complications occurrence （P〈0.05）. Conclusions：Plasma levels of HMGBI seem to be most suitable for severity assessment and prediction of post-traumatic complications occurrence in patients with severe blunt chest trauma.