脓毒症患者外周血HMGB1、TLRs水平与应激性溃疡的相关性

Correlations Between HMGB1 and TLRs Levels in Peripheral Blood with Stress Ulcer in Patients with Sepsis

目的探讨脓毒症患者外周血高迁移率族蛋白B1(HMGB1)、Toll样受体(TLRs)水平与应激性溃疡的相关性。方法回顾性分析2016年8月~2017年4月期间于笔者医院诊治的133例脓毒症患者并根据严重程度将其分为脓毒症组(62例)与严重脓毒症组(71例),根据是否发生应激性溃疡将其分为阳性组与阴性组,另以58例健康志愿者为对照组。实时荧光定量PCR法检测外周血HMGB1、Toll样受体2(TLR2)与Toll样受体4(TLR4)表达量,观察并比较阳性与阴性组患者血清前炎因子与氧化应激指标等。Logistic法分析影响脓毒症患者发生应激性溃疡的因素;受试者工作特征曲线(ROC)分析检测HMGB1、TLR2、TLR4对应激性溃疡的预测价值。结果脓毒症组患者外周血HMGB1、TLR2、TLR4水平均显著高于对照组(P=0.000、0.000、0.000),且严重脓毒症组显著高于脓毒症组(P=0.000、0.002、0.000),阳性组显著高于阴性组(P=0.000、0.000、0.000);与阴性组比较,阳性组IL-1β、IL-6、IL-8、TNF-α、NO、MDA、hs-CRP、PCT水平及APACHEⅡ评分均显著升高(P=0.000、0.006、0.000、0.000、0.003、0.000、0.005、0.004、0.000、0.000、0.000),而SOD水平显著降低(P=0.000);Logistic分析显示脓毒症患者外周血HMGB1、TLR2与TLR4水平均为应激性溃疡的独立影响因素;ROC分析显示HMGB1、TLR2与TLR4的AUC分别为0.866、0.765、0.811。结论脓毒症患者外周血HMGB1、TLR2与TLR4水平升高可影响机体炎症及应激反应程度并导致应激性溃疡的发生,且均可为临床预测应激性溃疡的重要因子。

Objective To investigate the correlations between the levels of high mobility group box protein B1 (HMGB1),Toll-like receptors (TLRs) and stress ulcer in patients with sepsis.Methods A retrospective analysis of 133 patients with sepsis in our hospital from August 2016 to April 2017 was conducted and they were divided into sepsis group (62 cases) and severe sepsis group (71 cases) according to the severity of disease,according to whether there was stress ulcer,the patients were divided into positive group and negative group,and another 58 healthy volunteers were selected as the control group.The expressions of HMGB1,Toll like receptor 2 (TLR2) and Toll like receptor 4 (TLR4) in peripheral blood was detected by qRT-PCR,and the serum proinflammatory factors and oxidative stress indexes in positive and negative groups were compared.The Logistic method was used to analyze the factors affecting stress ulcers in patients with sepsis,and receiver operating characteristic curve (ROC) analysis was used to detect the predictive value of HMGB1,TLR2,and TLR4 for stress ulcers.Results The levels of HMGB1,TLR2 and TLR4 in the peripheral blood of patients in the sepsis group were significantly higher than those in the control group ( P= 0.000,0.000,0.000),and the severe sepsis group was significantly higher than the sepsis group ( P= 0.000,0.002,0.000),and the positive group was significantly higher than the negative group ( P= 0.000,0.000,0.000).Compared with the negative group,the IL-1β,IL-6,IL-8,TNF-α,NO,MDA,hs-CRP,PCT levels and APACHE Ⅱ scores in the positive group were significantly increased ( P= 0.000,0.006,0.000,0.000,0.003,0.000,0.005,0.004,0.000,0.000,0.000),but the SOD level decreased significantly ( P= 0.000).Logistic analysis showed that peripheral blood HMGB1,TLR2 and TLR4 levels were independent factors of stress ulcer in sepsis patients.ROC analysis showed that the AUCs of HMGB1,TLR2 and TLR4 were 0.866,0.765 and 0.811 respectively.Conclusion The increase of HMGB1,TLR2 and TLR4 levels in peripheral blood of patients with sepsis may affect the degrees of inflammation and stress response and lead to stress ulcers,and can also be an important factor in predicting stress ulcers.