血清HMGB1在新生儿呼吸道合胞病毒感染诱导毛细支气管炎中的动态变化及临床意义

Dynamic changes and clinical significance of serum HMGB1 in neonatal bronchitis induced by respiratory syncytial virus infection

目的分析血清高迁移率族蛋白B1(high mobility group protein box 1,HMGB1)在新生儿呼吸道合胞病毒(respiratory syncytial virus,RSV)感染诱导毛细支气管炎中的动态变化及临床意义,为RSV毛细支气管炎的诊断和治疗提供新的思路。方法2020年10月1日至2021年5月31日,我院新生儿科被诊断为RSV感染且住院治疗的毛细支气管炎足月新生儿86例,被纳入研究作为研究组,同时纳入100例健康足月新生儿作为健康对照组。在研究组患儿急性期和恢复期时采集血清样本,采用ELISA试剂盒测定血清HMGB1水平,绘制受试者工作特征曲线,确定血清HMGB1用于RSV毛细支气管炎诊断的曲线下面积(AUC)。Spearman秩相关系数分析血清HMGB1与其他临床参数的关系。结果研究组新生儿急性期[0.455(0.196,0.632)ng/mL vs 0.112(0.054,0.261)ng/mL,P<0.01]和恢复期时[0.237(0.148,0.374)ng/mL vs 0.112(0.054,0.261)ng/mL,P<0.01],血清HMGB1水平均高于健康对照组,且急性期时升高更明显。急性期血清HMGB1水平用于RSV毛细支气管炎诊断的AUC为0.787(95%CI:0.725~0.849,P<0.01)。研究组患儿急性期血清HMGB1水平与王氏毛细支气管炎严重程度评分(r=0.295,P<0.01)、呼吸支持(r=0.476,P<0.01)、出生体重(r=0.404,P<0.01)、入院时外周血单核细胞计数(r=0.409,P<0.01)、淋巴细胞计数(r=0.508,P<0.01)及CRP水平(r=0.402,P<0.01)呈正相关性。结论RSV感染毛细支气管炎新生儿血清HMGB1水平升高与机体炎症反应相关。

Objective To analyze the dynamic changes and clinical significance of serum high mobility group protein box 1(HMGB1)in neonatal respiratory syncytial virus(RSV)infection induced bronchiolitis,so as to provide new ideas for the diagnosis and treatment of RSV bronchiolitis.Methods From October 1,2020 and May 31,2021,86 full-term neonates diagnosed as RSV infection and hospitalized for bronchiolitis in our neonatal unit were enrolled in the study as the study group.One hundred full-term healthy newborns were included as the control group.In the study group,acute phase and recovery phase blood samples were collected and serum HMGB1 levels were measured by ELISA kit.Receiver operating characteristic curve was constructed to determine the area under the curve(AUC)of serum HMGB1 for RSV bronchiolitis diagnosis.Spearman rank correlation coefficient was used to analyze the relationship between serum HMGB1 and other clinical parameters.Results The levels of serum HMGB1 in the study group were higher than those in control group both in acute phase[0.455(0.196,0.632)ng/mL vs 0.112(0.054,0.261)ng/mL,P<0.001]and in convalescent phase[0.237(0.148,0.374)ng/mL vs 0.112(0.054,0.261)ng/mL,P<0.01].The elevated level of serum HMGB1 in acute phase was also higher than that in convalescent phase.The AUC of serum HMGB1 at the acute phase for diagnosis of RSV bronchiolitis was 0.787(95%CI:0.725-0.849,P<0.01).The serum HMGB1 level at the acute phase in the study group was positively correlated with the Wang’s bronchiolitis score(r=0.295,P<0.01),respiratory support(r=0.476,P<0.01),birth weight(r=0.404,P<0.01),peripheral blood monocytes(r=0.409,P<0.01),lymphocytes(r=0.508,P<0.01)and CRP level(r=0.402,P<0.01).Conclusions The increase of serum HMGB1 level in neonates with RSV induced bronchiolitis could be related to the inflammatory response.