血清高迁移率族蛋白B1在急性化脓性胆管炎发生中的作用及意义研究

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

目的检测急性化脓性胆管炎（ASC）患者血清高迁移率族蛋白B1（HMGB1）的水平变化，探讨HMGB1在疾病发生中的作用及意义。方法以30例重症急性胆管炎、42例轻症急性胆管炎以及50例健康体检者为研究对象，在起病72h内收集血标本，采用酶联免疫吸附方法（ELISA）检测血清HMGB1水平，用实时荧光定量PCR检测血清YIMGB1mRNA的表达，分析其与病情轻重的关系以及HMGB1与其他生化指标的相关性。结果健康对照组、轻症组、重症组血清HMGB1水平分别为（1．82±0．64）μg／L，（10．46±3．75）μg/L、（18．89±6．86）μg/L，轻症组显著高于健康对照组，重症组显著高于轻症组（P〈0．05）；胆管炎患者HMGB1mRNA表达明显增高，重症组高于轻症组（P〈0．05）。胆汁和（或）血培养阳性的患者血清HMGB1水平高于培养阴性者；重症急性胆管炎行急诊鼻胆管引流术后血清HMGB1水平较术前明显降低（P〈0．05）。血清HMGB1水平与白细胞、C反应蛋白、总胆红素、直接胆红素、碱性磷酸酶呈正相关关系；通过Logistic回归分析血清HMGB1水平与疾病严重程度相关。结论血清HMGB1水平在急性胆管炎时显著升高，重症急性化脓性胆管炎患者明显高于轻症患者，并与脓毒血症相关。鼻胆管引流可明显降低其血清水平，血清HMGB1水平对疾病严重程度有一定预测价值。

Objective To observe the serum levels of high mobility group box-1 protein （ HMGBI ） in patients with acute cholangitis （AC） and to investigate contributions of HMGB1 in AC. Methods Serum HMGB1 concentrations were determined by an enzyme-linked immunosorbent assay in 30 patients with AC of severe type （ACST） and 42 patients with mild acute cholangitis at the time of admission （ within 72 h after the onset）. A total of 50 heahhy subjects were recruited as the control group. Fluorescent quantitative PCR （FQPCR） was used to detect the HMGB1 mRNA expression and the relationship between serum HMGB1 levels and clinical factors was analyzed. Results The serum HMGB1 levels in healthy control group, mild group and ACST group were （ 1.82 ± 0. 64） μg/L, （ 10. 46 ± 3.75 ）μg/L, （ 18. 89 ± 6. 86 ） μg/L, respectively. The mean value of serum HMGB1 level in mild group was significantly higher than that in control group, while significantly lower than that in ACST group （ P 〈 0. 05 ）. Compared to the control group, the HMGB1 mRNA level in patients of AC increased significantly and the level of ACST group was higher than that of mild group. The serum HMGB1 levels of patients with positive bile or/and blood cultures were higher than that of negative. After emergency endoscopic nasal biliary drainage, the serum HMGB1 levels of pa- tients significantly decreased compared to preoperational （P 〈 O. 05 ）. The HMGB1 levels were significantly positively correlated with white cell counts, C-reactive protein （CRP） , total serum bilirubin, direct bilirubin and alkaline phosphatase （ALP）. By logistic regression analysis, serum HMGB1 levels had correlation with severity of disease. Conclusion Serum HMGB1 levels significantly increased in patients with AC and the serum concentrations of ACST group were higher than those of mild group. Serum HMGB1 level has a correlation with sepsis. ENBD could lower its serum levels. Serum HMGB1 has predictive value to severity of disease.