北方地区蝮蛇咬伤患者血清高迁移率族蛋白 B1水平动态变化的临床研究

Clinical study of the dynamic changes of serum high mobility group protein B1 of Agkistrodon Halys bite patients in north China

目的：探讨北方地区蝮蛇咬伤患者血清高迁移率族蛋白B1（ HMGB1）水平的变化及临床意义。方法将87例北京及周边省市来我院就诊的蝮蛇咬伤中毒患者，根据毒蛇咬伤的临床分型及严重程度评分标准分成轻型、重型、危重型三组，分别于伤后就诊当天（未进行任何治疗前），就诊第2天和第7天采集静脉血标本各三份，另以30名健康体检者的血清作为正常对照组，采用酶联免疫吸附剂测定法（ ELISA）测定不同时期血清HMGB1水平，各组之间比较并进行统计学分析。结果不同时期蝮蛇咬伤患者的血清HMGB1水平均高于正常对照组（ P＜0.05）；重型高于轻型，危重型中毒组患者明显高于轻型和重型中毒组患者（P＜0．05）；轻型、重型就诊第2天血清HMGB1水平明显高于就诊当天，第7天血清 HMGB1水平较第2天明显下降（ P＜0.05），但仍高于就诊当天（ P＞0．05）。危重型就诊第2天血清HMGB1水平较就诊当天升高（P＞0．05），第7天血清HMGB1水平仍高于就诊当天，较第2天下降，但差异均无统计学意义（P＞0．05）。结论北方地区蝮蛇咬伤患者血清HMGB1水平均明显升高，它可能协同参与了蝮蛇咬伤中毒患者的病情发生、发展过程，其升高水平可以作为反映中毒严重程度的参考指标。动态观察其水平的变化可以指导蛇咬伤患者的治疗，帮助判断患者的预后。

Objective To explore the dynamic changes and clinical manifestations of serum high mobility group protein B 1 of Agkistrodon Halys bite patients in north China .Methods According to clinical classification and severity grade of snake bites , we divided 87 Agkistrodon Halys bite poisoning cases into three groups：mild, severe and critical type .These patients were from Beijing or its surrounding provinces .We extracted intravenous blood of three different stage of the treatment： before treatment, two days after treatment and seven days after treatment .We also compared them to 40 healthy samples, using Enzyme -linked immunosorbent assay （ ELISA ） method to determinate the serum HMGB1 level in different periods .Finally we compared the differences between each group and analyzed the results with statistical methods .Results The serum HMGB1 levels of all the three groups of Agkistrodon Halys bite patients were higher than those normal samples （P〈0.05）.Serum HMGB1 in severe group was higher than that in the mild group .Serum HMGB1 in critical group was significantly higher than that in the other two groups （P〈0.05）.For the mild and the severe groups, the Serum HMGB1 levels after two days of treatment were significantly higher than those before treatment .The levels of serum HMGB1 after seven -day treatment were decreased significantly compared with those＆amp;nbsp;after tow -day treatment （P 〈0.05）.Although decreased, the levels of HMGB1 after seven -day treatment were still higher than those before treatment （P〉0.05）.For the critical groups, the levels of serum HMGB1 after two-day treatment were higher than those before treatment （ P〉0 .05 ） .And the levels of serum HMGB1 after seven -day treatment were still higher than those before treatment , but were not significantly lower than those of two -day treatment （P〉0.05）.Conclusion The levels of serum HMGB1 of Agkistrodon Halys bite patients in north China increase significantly .HMGB1 may be involved in the Agkistrodon Halys bite patient＆#39;s condition occurs and development process .It can serve as a reference index which reflects the severity of poisoning .Dynamic observation of HMGB1 can guide the treatment of Agkistrodon Halys bite patients , and help determine the prognosis of patients .