重症肺炎并发脓毒症患者血清高迁移率族蛋白B1检测的临床意义
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摘要
目的探讨重症肺炎并发脓毒症患者血清高迁移率族蛋白B1(HMGB1)水平变化的临床意义。方法选择2014年4月至2017年3月新乡市中心医院呼吸重症监护病房(RICU)收治的50例重症肺炎并发脓毒症患者作为观察组,按患者的预后分为死亡组(n=32)和存活组(n=18)。另选取同期50例体检健康者为对照组。观察组患者在入住RICU的第1、3、7天检测血清HMGB1和降钙素原(PCT)水平,并对患者进行急性生理和慢性健康状况评估(APACHE)Ⅱ评分;对照组受试者体检时检测血清HMGB1、PCT水平。结果死亡组和存活组患者平均动脉压、氧合指数、体温及白细胞计数比较差异均无统计学意义(P>0.05)。入住RICU第1天,观察组患者血清HMGB1及PCT水平均高于对照组(P<0.05)。死亡组患者各时间点HMGB1水平和APACHEⅡ评分均高于存活组(P<0.05)。入住RICU第1天死亡组与存活组患者PCT水平比较差异无统计学意义(P>0.05),其余各时间点死亡组患者PCT水平均高于存活组(P<0.05)。观察组患者血清HMGB1水平与PCT、APACHEⅡ评分均呈正相关(r=0.562、0.460,P<0.05)。结论重症肺炎并发脓毒症患者血清HMGB1水平升高,且死亡患者血清中HMGB1水平升高较存活患者更明显,因此,HMGB1可用于评估病情及判断预后。
Objective To investigate the clinical significance of the changes of serum level of high mobility group protein B1( HMGB1) in patients with severe pneumonia complicated with sepsis. Methods Fifty patients with severe pneumonia complicated with sepsisin in Respiratory Intensive Care Unit( RICU) of Xinxiang Central Hospital from April 2014 to March 2017 were selected as observation group; while 50 healthy individuals were selected as control group. The patients in the observation group were divided into death group( n = 32) and survival group( n = 18) according to the prognosis. The serum levels of procalcitonin( PCT) and HMGB1 of patients in the observation group were detected on the 1~(st),3~(rd),7~(th) day of patients hospitalized in the RICU,while the acute physiology and chronic health evaluation Ⅱ( APACHEⅡ) scores of the patients were evaluated. The serum levels of PCT and HMGB1 of subjects in the control group were detected during physical examination. Results There was no statistic difference in the mean arterial pressure,oxygenation index,body temperature and total white cell count of patients between the death group and survival group( P > 0. 05). On the first day of patients hospitalized in the RICU,the serum levels of PCT and HMGB1 of patients in the observation group were significantly higher than those in the control group( P <0. 05). The serum levels of HMGB1 and the APACHEⅡscores of patients in the death group were significantly higher than those in the survival group at each time point( P < 0. 05). On the first day of patients hospitalized in the RICU,there was no statistic difference in the serum level of PCT of patients between the death group and survival group( P > 0. 05); the serum level of PCT of patients in the death group was significantly higher than that in the survival group at another time point( P < 0. 05). The serum level of HMGB1 of patients in the observation group was positively correlated with the PCT and APACHE Ⅱ score( r = 0. 562,0. 460; P < 0. 05). Conclusion The serum level of HMGB1 in patients with severe pneumonia complicated with sepsis is increased; and the increase of serum level of HMGB1 in the death cases is more obvious than that in the survival cases. So it can be used to evaluate the patient's condition and judge the prognosis.
Objective To investigate the clinical significance of the changes of serum level of high mobility group protein B1( HMGB1) in patients with severe pneumonia complicated with sepsis. Methods Fifty patients with severe pneumonia complicated with sepsisin in Respiratory Intensive Care Unit( RICU) of Xinxiang Central Hospital from April 2014 to March 2017 were selected as observation group; while 50 healthy individuals were selected as control group. The patients in the observation group were divided into death group( n = 32) and survival group( n = 18) according to the prognosis. The serum levels of procalcitonin( PCT) and HMGB1 of patients in the observation group were detected on the 1~(st),3~(rd),7~(th) day of patients hospitalized in the RICU,while the acute physiology and chronic health evaluation Ⅱ( APACHEⅡ) scores of the patients were evaluated. The serum levels of PCT and HMGB1 of subjects in the control group were detected during physical examination. Results There was no statistic difference in the mean arterial pressure,oxygenation index,body temperature and total white cell count of patients between the death group and survival group( P > 0. 05). On the first day of patients hospitalized in the RICU,the serum levels of PCT and HMGB1 of patients in the observation group were significantly higher than those in the control group( P <0. 05). The serum levels of HMGB1 and the APACHEⅡscores of patients in the death group were significantly higher than those in the survival group at each time point( P < 0. 05). On the first day of patients hospitalized in the RICU,there was no statistic difference in the serum level of PCT of patients between the death group and survival group( P > 0. 05); the serum level of PCT of patients in the death group was significantly higher than that in the survival group at another time point( P < 0. 05). The serum level of HMGB1 of patients in the observation group was positively correlated with the PCT and APACHE Ⅱ score( r = 0. 562,0. 460; P < 0. 05). Conclusion The serum level of HMGB1 in patients with severe pneumonia complicated with sepsis is increased; and the increase of serum level of HMGB1 in the death cases is more obvious than that in the survival cases. So it can be used to evaluate the patient's condition and judge the prognosis.
引文
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[10]郭剑颖,邓群,郭旭升.乌司他丁和胸腺肽α1联合治疗严重脓毒症的组织病理学观察[J].南方医科大学学报,2012,32(6):830-834.
[11]IANNELLA H A,LUNA C M.Community-acquired pneumonia in Latin America[J].Semin Respir Crit Care Med,2016,37(6):868-875.
[12]ZHOU H,JI X,WU Y,et al.A dual-role of Gu-4 in suppressing HMGB1 secretion and blocking HMGB1 pro-inflammatory activity during inflammation[J].PLo S One,2014,9(3):e89634.
[13]LIU Z,LIU J,WANG J,et al.Role of testis-specific high-mobilitygroup protein in transcriptional regulation of inducible nitric oxide synthase expression in the liver of endotoxic shock mice[J].FEBS J,2014,281(9):2202-2213.
[14]赵华杰,宋诗铎,刘毅.脓毒症患者血清高迁移率族蛋白B1水平及与临床相关指标的关系[J].临床荟萃,2011,26(10):845-847.
[15]WANG H,LIU D.Baicalin inhibits high-mobility group box 1 release and improves survival in experimental sepsis[J].Shock,2014,41(4):324-330.
[16]陈炎堂,曾勉,黄炎明,等.高迁移率族蛋白B1在重症肺炎患者中的临床研究[J].中华医院感染学杂志,2014,26(6):1558-1560.
[17]ANGUS D C,YANG L,KONG L,et al.Circulating high-mobility group box 1(HMGB1)concentrations are elevated in both uncomplicated pneumonia and pneumonia with severe sepsis[J].Crit Care Med,2007,5(4):1061-1067.
[2]张亮,刘万周,程涛.降钙素原和急性生理与慢性健康评分Ⅱ对脓毒症患者预后的评估[J].新乡医学院学报,2016,33(7):629-631.
[3]刘翠,刘舒,黄锦达,等.微小RNA-30e在脓毒症急性肺损伤大鼠中的表达及其与炎性因子水平的相关性[J].中华实用儿科临床杂志,2016,31(6):417-420.
[4]CHALMERS J D.The modern diagnostic approach to community acquired pneumoniain adults[J].Semin Respir Crit Care Med,2016,37(6):876-885.
[5]PEREIRA J M,PAIVA J A,RELLO J.Severe sepsis in communityacquired pneumonia-early recognition and treatment[J].Eur J Intern Med,2012,23(5):412-419.
[6]KIM S W,JIN Y,SHIN J H,et al.Glycyrrhizic acid affords robust neuroprotection in the postischemic brain via anti-inflammatory effect by inhibiting HMGB1 phosphorylation and secretion[J].Neurobiol Dis,2012,46(1):147-156.
[7]中华医学会呼吸病学分会.社区获得性肺炎诊断和治疗指南[J].中华结核和呼吸杂志,2006,29(10):651-655.
[8]FEDOSOV V,DZIADZKO M,DEARANI J A,et al.Decision support tool to improve glucose control complicance after cardiac surgery[J].AACN Adv Crit Care,2016,27(3):274-278.
[9]YANG Y,XIE J F,YU K J,et al.Epidemiological study of sepsis in China:protocol of across-sectional survey[J].Chin Med J(Engl),2016,129(24):2967-2973.
[10]郭剑颖,邓群,郭旭升.乌司他丁和胸腺肽α1联合治疗严重脓毒症的组织病理学观察[J].南方医科大学学报,2012,32(6):830-834.
[11]IANNELLA H A,LUNA C M.Community-acquired pneumonia in Latin America[J].Semin Respir Crit Care Med,2016,37(6):868-875.
[12]ZHOU H,JI X,WU Y,et al.A dual-role of Gu-4 in suppressing HMGB1 secretion and blocking HMGB1 pro-inflammatory activity during inflammation[J].PLo S One,2014,9(3):e89634.
[13]LIU Z,LIU J,WANG J,et al.Role of testis-specific high-mobilitygroup protein in transcriptional regulation of inducible nitric oxide synthase expression in the liver of endotoxic shock mice[J].FEBS J,2014,281(9):2202-2213.
[14]赵华杰,宋诗铎,刘毅.脓毒症患者血清高迁移率族蛋白B1水平及与临床相关指标的关系[J].临床荟萃,2011,26(10):845-847.
[15]WANG H,LIU D.Baicalin inhibits high-mobility group box 1 release and improves survival in experimental sepsis[J].Shock,2014,41(4):324-330.
[16]陈炎堂,曾勉,黄炎明,等.高迁移率族蛋白B1在重症肺炎患者中的临床研究[J].中华医院感染学杂志,2014,26(6):1558-1560.
[17]ANGUS D C,YANG L,KONG L,et al.Circulating high-mobility group box 1(HMGB1)concentrations are elevated in both uncomplicated pneumonia and pneumonia with severe sepsis[J].Crit Care Med,2007,5(4):1061-1067.