血清高迁移率族蛋白-1在继发性噬血细胞性淋巴组织细胞增多症的表达及临床意义

Expression of Serum HMGB-1 in Patients with Secondary Hemophagocytic Lymphohistiocytosis and Its Clinical Significance

目的:探讨血清高迁移率族蛋白B-1(High mobility group box 1,HMGB-1)在继发性噬血细胞性淋巴组织细胞增多症(Secondary hemophagocytic lymphohistiocytosis,s HLH)中的表达及其临床意义。方法:收集51例s HLH患者及15例正常体检者作为对照的外周血清标本,以ELISA法检测血清HM GB-1水平。收集患者实验室检查数据,包括血清可溶性白介素-2受体(s CD25)、白细胞(WBC)、血红蛋白(Hb)、血小板(Plt)、纤维蛋白原(FIB)、乳酸脱氢酶(LDH)、甘油三脂(TG)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、血清铁蛋白(SF)、C反应蛋白(CRP)及血沉(ESR)。结果:初诊s HLH组血清HMGB-1水平明显高于正常对照组(P<0.001)。初诊淋巴瘤相关HLH组(LHLH)血清HM GB-1水平明显高于非LHLH组(感染相关HLH及风湿免疫相关HLH)(P<0.05)。治疗后临床缓解的s HLH组血清HMGB-1水平明显低于初诊s HLH组(P<0.05),而进展/复发组血清HMGB-1水平与初诊组无明显差别(P>0.05)。初诊s HLH组血清HMGB-1水平与s CD25呈正相关关系(r=0.62,P<0.01)、与ESR同样呈正相关关系(r=0.55,P=0.01)。血清HMGB-1以15.3μg/L为最佳临界值,其区别s HLH及正常对照组的敏感性及特异性分别为90%及99%;以27.4μg/L为最佳临界值,其区别LHLH组及非LHLH组的敏感性及特异性分别为96%及81%。结论:血清HMGB-1在s HLH患者的诊断、病因鉴别诊断、病情活动、疗效评估等方面具有重要的临床意义。

Objective: To investigate the expression levels and clinical significance of serum high mobility group box1( HM GB-1) in patients w ith secondary hemophagocytic lymphohistiocytosis( s HLH). Methods: Serum HM GB-1levels w ere determined by using enzyme linked immunosorbent assays( ELISA) in 51 s HLH patients and 15 healthy contrlols. Other laboratory data, including soluble interleukin-2 receptor( s CD25), w hite blood cells( WBC),hemoglobin( Hb),platelet( Plt),fibrinogen( FIB),lactate dehydrogenase( LDH),triglyceride( TG),alanine transaminase( ALT),aspartate aminotransferase( AST),serum ferritin( SF),C reactive protein( CRP),and blood sedimentation rate( ESR) w ere also collected. Results: Serum HM GB-1 levels in the new ly diagnosed group w ere significantly higher than that in the control group( P < 0. 01). Serum HM GB-1 levels in the new ly diagnosed lymphomaassociated HLH( LHLH) group w ere significantly higher than that in non-HLH group,including infection-associated HLH( IHLH) and autoimmune-associated HLH( AHLH) group( P < 0. 05); The serum HM GB-1 levels in the clinical remission group w ere significantly low er than that in the new ly diagnosed group( P < 0. 05),how ever,serum HM GB-1w as not decreased significantly in the progression / relapsed group,compared w ith the new ly diagnosed group( P >0. 05). Serum HM GB-1 levels in new ly diagnosed s HLH patients positively correlated w ith s CD25( r = 0. 62,P < 0. 01)and ESR( r = 0. 55,P < 0. 05). The receiver operating characteristic curves( ROC) for serum HMGB-1 levels of s HLH patients and healthy controls produced a cutoff value at 15. 3 μg / L,with its 90% sensitivity and 99% specificity,respectively.In addition,an optimal cutoff value for HM GB-1 w as 27. 4 μg / L in the patients LHLH and non-HLH( AHLH + IHLH)w ith 96% sensitivity and 81% specificity,separately. Conclusion: Serum HM GB-1 levels possesses an important clinically significance for disease diagnosis,differential diagnosis,evaluation of nosographic activity and treatment efficacy in the patients w ith s HLH.