高迁移率族蛋白B1在重症肺炎患者中的临床研究

Clinical study of high mobility group box-1 in patients with severe pneumonia

目的观察重症肺炎患者血清及肺泡灌洗液中高迁移率族蛋白B1(HMGBl)的水平及变化趋势,探讨其与重症肺炎患者病情严重程度的关系。方法选择2010年12月-2011年6月行机械通气的42例重症肺炎患者,将其预后分为存活组及死亡组;以同期14名健康体检者为阴性对照组,检测重症肺炎患者在入住重症医学科的第1、3、7天及转出ICU(或死亡)当天的血清及肺泡灌洗液中HMGBl、PCT水平及行APACHEⅡ评分;健康体检者体检时的血清HMGB1、PCT水平;根据原始数据录入SPSS13.0统计软件,以P<0.05为差异有统计学意义。结果入住重症医学科第1天重症肺炎组血清HMGB1(172.10±15.32)μg/L高于对照组的(4.73±1.49)μg/L(P<0.05);第3、7天及转科(死亡)当天,死亡组的血清和肺泡灌洗液HMGB1浓度分别为(202.41±20.98)、(218.86±25.42)、(225.37±24.30)μg/L及(8.79±1.91)、(10.87±1.31)、(12.08±1.85)μg/L,均高于存活组(P<0.05);血清及肺泡灌洗液HMGB1水平存活组逐渐下降,死亡组逐渐上升;血清和肺泡灌洗液HMGB1水平与APACHEⅡ评分呈直线相关(r=0.334,P=0.009和r=0.298,P=0.031);血清与肺泡灌洗液HMGB1水平呈正相关(r=0.339,P=0.014)。结论基础APACHEⅡ评分越高预后越差,HMGB1水平能反映炎症及组织损伤的轻重程度,能协助评价病情、判断预后;重症肺炎患者局部及全身炎症反应存在有一定的关联性。

OBJECTIVE To investigate the trends of the concentrations of high mobility group box-1 （HMGB1） in serum and bronehoalveolar lavage fluid and explore the correlation between the level of HMGB1 and the severity of disease. METHODS A total of 42 patients with severe pneumonia who received mechanical ventilation from Dee 2010 to Jun 2011 were enrolled in the study and divided into the survival group and the death group according to their prognosis, while 14 healthy individuals were enrolled as the normal control group, then the APACHE 1I scores for the severe pneumonia patients at day 1,3, 7 and the day of discharge from ICU or death were determined, and the levels of serum HMGB1 and PCT of the healthy individuals were observed, the original data were input to the SPSS13.0 software, and P〈0.05 was defined as statistical significance. RESULTS The severe pneumonia patients had higher serum H MGB1 （172.10 ± 15.32） μg/L than did the normal control group（4.73 ± 1.49） 〉g/L at day 1; the concentrations of the serum HMGB1 and BAL fluid HMGB1 of the death group were respectively （202.41±20.98） μg/L, （218. 86±25.42） μg/L, （225. 37±24.30）μg/L, （8. 79±1. 91） μg/L, （10.87±1.31）, and （12. 08±1.85）μg/L, higher than those of the surgery group（P〈0.05）; the levels of the serum and BAL fluid HMGB1 were decreased in the survival group and elevated in the death group. The levels of the serum and BAL HMGB1 showed a linear correlation with the APACHE II scores（r= 0. 334,P= 0. 009 and r=0. 298,P = 0. 031）; the level of serum HMGB1 was positively correlated with the level of BAL HMGB1 （r= 0. 339,P=0. 014）. CONCLUSION The higher the baseline APACHER score, the poorer the prognosis; the level of HMGB1 can reflect the severity of the disease and has an effect on the prognosis prediction. There is certain correlation between the systemic inflammatory response and the local inflammatory response.