高迁移率族蛋白1预测呼吸机相关性肺炎患者近期死亡率的价值

Prognostic Value of High Mobility Group Protein 1 in Patients with Ventilator-Associated Pneumonia

目的探讨高迁移率族蛋白1（HMGB1）对呼吸机相关性肺炎（VAP）患者近期死亡率的预测价值。方法纳入2013年3月至2015年3月延安大学附属医院呼吸内科重症监护室中符合VAP诊断标准的患者118例,依据28 d是否发生死亡分为死亡组和生存组。分析两组间基础资料,以及诊断后第1、4和7 d的HMGB1、C反应蛋白（CRP）、临床肺部感染评分（CPIS）、急性生理学和慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、全身感染性相关器官功能衰竭评分（SOFA）等指标的差异,通过单因素和多因素分析筛选预测VAP近期死亡的危险因素,通过受试者工作特征（ROC）曲线分析危险因素预测近期死亡率的准确性。结果存活组87例,死亡组31例。死亡组和生存组之间年龄、性别、体重指数,以及各时间点的HMGB1水平、APACHEⅡ和SOFA评分等指标比较,差异有统计学意义（P〈0.05）。单因素分析显示第4 d的HMGB1（P=0.031）、APACHEⅡ（P=0.018）和SOFA评分（P=0.048）,第7 d的HMGB1（P=0.087）、APACHEⅡ（P=0.073）和SOFA评分（P=0.049）与VAP患者28 d死亡密切相关。多因素分析显示第4 d的HMGB1（HR=1.43,95%CI 1.07~1.78,P=0.021）,第4 d的SOFA评分（HR=1.15,95%CI 1.06~1.21,P=0.019）和第7 d的HMGB1（HR=1.27,95%CI 1.18~1.40,P=0.003）是预测VAP患者近期死亡的独立危险因素。ROC曲线分析显示第4 d的HMGB1〉51.2μg/L（敏感性92.7%,特异性81.9%）,第4 d的SOFA评分〉7.9（敏感性68.9%,特异性71.0%）,第7 d的HMGB1〉47.5μg/L（敏感性73.2%,特异性88.2%）是预测VAP患者28 d死亡的理想阈值。结论 HMGB1是一种可有效预测VAP近期死亡率的新指标。

Objective To investigate the prognostic value of high mobility group protein 1（ HMGB1） in patients with ventilator-associated pneumonia（ VAP）. Methods A total 118 VAP patients admitted between March 2013 and March 2015 were recruited in the study. The patients were divided into a death group and a survival group according to 28-day death. Baseline data,HMGB1,C-reactive protein（ CRP）,clinical pulmonary infection score（ CPIS）,acute physiology and chronic health evaluation Ⅱ（ APACHEⅡ） and sepsis-related organ failure assessment（ SOFA） scores were collected on 1stday（ d1）,4thday（ d4）,and 7thday（ d7） after VAP diagnosis. The possible prognostic factors were analyzed by univariate and logistic multivariate analysis. Results There were 87 cases in the survival group and 31 cases in the death group. Age,female proportion,body mass index,HMGB1（ d1,d4,d7）,APACHEⅡ（ d1,d4,d7） and SOFA（ d1,d4,d7） scores were all higher in the death group than those in the survival group（ all P〈0. 05）. HMGB1（ d4,P = 0. 031）,APACHE Ⅱ（ d4,P = 0. 018）,SOFA（ d4,P =0. 048）,HMGB1（ d7,P = 0. 087）,APACHE Ⅱ（ d7,P = 0. 073） and SOFA（ d7,P = 0. 049） were closely correlated with 28-day mortality caused by VAP. Multivariate analysis revealed that HMGB1（ d4,HR = 1. 43,95% CI 1. 07 to 1. 78,P = 0. 021）,SOFA（ d4,HR = 1. 15,95% CI 1. 06 to 1. 21,P =0. 019） and HMGB1（ d7,HR = 1. 27,95% CI 1. 18 to 1. 40,P = 0. 003） were independent predictors of death in the VAP patients. ROC curve revealed HMGB1（ d4,d7） and SOFA（ d4） with area under ROC curve of 0. 951,0. 867 and 0. 699. Conclusion Individual HMGB1 level can be used as a good predictor of the short-outcomes of VAP.