血清高迁移率族蛋白B1检测在脓毒症合并ARDS患者中的临床监测效果研究

Clinical monitoring effects of serum high mobility group box protein B1 detection in patients with sepsis complicated with ARDS

目的研究血清高迁移率族蛋白B1(HMGB1)检测在脓毒症合并急性呼吸窘迫综合征(ARDS)患者中的临床应用效果。方法将该院2016年6月至2018年6月收治的48例脓毒症患者纳为研究对象,根据其是否合并ARDS将其分为单纯脓毒症组(n=30)与脓毒症合并ARDS组(n=18),比较两组患者一般资料,并分别在患者入院后第1、3天,采集其静脉血,检测常规血生化、血清炎症介质及血清HMGB1水平,分析脓毒症合并ARDS的危险因素。结果脓毒症合并ARDS组患者脓毒症相关器官衰竭评分(SOFA)及急性生理和慢性疾病评分Ⅱ(APACHEⅡ)评分均显著高于单纯脓毒症组患者(P<0.05),两组患者年龄、性别、住院时间、机械通气时间、住ICU时间及抗菌药物使用时间差异均无统计学意义(P>0.05);入院后第1天,脓毒症合并ARDS组患者血清白细胞介素-6(IL-6)水平显著高于单纯脓毒症组(P<0.05),第3天两组IL-6水平差异无统计学意义(P>0.05),此外,入院第1、3天,两组白细胞计数(WBC)、血小板计数(PLT)、降钙素原(PCT)及C-反应蛋白(CRP)水平均差异无统计学意义(P>0.05);脓毒症合并ARDS组患者入院第1、3天内血清HMGB1水平均显著高于单纯脓毒症组患者(P<0.05);经多因素Logistic回归分析提示,入院第1天高水平HMGB1是脓毒症并发ARDS的危险因素。结论入院第1天脓毒症患者血清高HMGB1水平是并发ARDS的独立危险因素,积极监测脓毒症患者血清HMGB1水平,在防治ARDS中具有积极意义。

Objective To study the clinical application effects of serum high mobility group box protein B1(HMGB1)in patients with sepsis complicated with acute respiratory distress syndrome(ARDS).Methods A total of 48 patients with sepsis admitted to the hospital from June 2016 to June 2018 were enrolled in the study.According to whether they were complicated with ARDS,they were divided into simple sepsis group(n=30)and sepsis with ARDS group(n=18).Thegeneral data were compared between the two groups,and the venous blood was collected on the 1st day and 3rd day after admission,and the routine blood biochemistry,serum inflammatory mediators and serum HMGB1 were measured,and the risk factors of sepsis with ARDS were analyzed.Results The scores of Sequential Organ Failure Assessment(SOFA)and Acute Physiology and Chronic Health Evaluation(APACHEⅡ)in sepsis with ARDS group were significantly higher than those in simple sepsis group(P<0.05),and there were no significant differences on the age,gender,hospital stay,mechanical ventilation time,ICU stay and antibiotic use time between the two groups(P>0.05).On the 1st day after admission,the serum interleukin-6(IL-6)level in sepsis with ARDS group was significantly higher than that in simple sepsis group(P<0.05),and there was no significant difference on the IL-6 level on the 3rd day between the two groups(P>0.05).In addition,there were no significant differences on the levels of white blood cells(WBC),platelets(PLT),procalcitonin(PCT)and C-reactive protein(CRP)on the 1st day and 3rd day after admission between the two groups(P>0.05).The serum HMGB1 level in sepsis with ARDS group on the 1st and 3rd day after admission was significantly higher than that in simple sepsis group(P<0.05).Multivariate Logistic regression analysis indicated that the high level of HMGB on the 1st day after admission was a risk factor for sepsis with ARDS.Conclusion The serum high HMGB1 level in patients with sepsis on the 1st day after admission is an independent risk factor for ARDS.Active monitoring of serum HMGB1 level in patients with sepsis is of positive significance in the prevention and treatment of ARDS.