一氧化碳中毒后迟发性脑病血清高迁移率族蛋白B1水平及临床意义

Serum levels and clinical signific ance of high mobility group protein B1 in patients with delayed encephalopathy after acute carbon monoxide poisoning

目的 探讨急性一氧化碳（CO）中毒后迟发性脑病患者血清高迁移率族蛋白B1（HMGB1）水平的变化及其临床意义.方法 CO中毒后迟发性脑病病例组34例、CO中毒组32例、对照组32例,采用酶联免疫吸附法（EHSA）检测血清HMGB1的水平,采用日常生活能力量表（ADL）、常识-记忆-注意测验（IMCT）、长谷川痴呆量表（HDS）比较血清HMGB1的水平变化及与量表评分的关系.结果 CO中毒后迟发性脑病组急性期血清HMGB1水平明显高于CO中毒组和对照组,差异有统计学意义（P＜0.01）.CO中毒后迟发性脑病病例组恢复期血清HMGB1水平明显低于急性期,差异有统计学意义（P＜0.05）;与恢复期比较,迟发性脑病病例组急性期ADL评分升高,HDS、IMCT评分降低,差异均有统计学意义（P＜0.01）.迟发性脑病病例组急性期、恢复期血清HMGB1水平与HDS和ADL评分呈正相关（相关系数分别为0.612、0.607、0.609、0.612,P＜0.01）.结论 HMGB1作为重要的晚期炎性介质参与了迟发性脑病病例组的炎症反应过程,且与HDS和ADL评分呈正相关,可作为急性一氧化碳中毒患者病情的主要监测指标之一.

Objective To investigate the changes in serum level of high mobility group protein B1 （HMGB1） in patients with delayed encephalopathy after acute carbon monoxide poisoning and the clinical significance of these changes.Methods Thirty-four patients with delayed encephalopathy after acute carbon monoxide poisoning （delayed encephalopathy group）,30 normal controls （control group）,and 32 cases of acute carbon monoxide poisoning without delayed encephalopathy （carbon monoxide poisoning group） were recruited in this study.The serum HMGBI level was determined by enzyme-linked immunosorbent assay.The correlation between serum HMGB 1 level and scores of the activity of daily living scale （ADL）,Information-Memory-Concentration Test （IMCT）,and Hasegawa dementia scale （HDS） was determined.Results In the acute stage of carbon monoxide poisoning,the serum HMGB 1 level of delayed encephalopathy group was significantly higher than those of the carbon monoxide poisoning group and the control group （P〈0.01）.In the delayed encephalopathy group,serum HMGB 1 level in the convalescent stage was significantly lower than that in the acute stage （P〈0.05）; ADL score was higher and HDS and IMCT scores were lower in the acute stage than in the convalescent stage （P〈 0.01）.In the delayed encephalopathy group,serum HMGB1 level was positively correlated with HDS and ADL scores in both acute stage and convalescent stage （correlation coefficients：0.612,0.607,0.609,and 0.612,P〈 0.01）.Conclusion HMGB1,as an important late mediator of inflammation,is involved in the inflammatory reaction in delayed encephalopathy,and is positively correlated with HDS and ADL scores,indicating that it can be used as one of the major indicators in monitoring carbon monoxide poisoning.