创伤性急性肺损伤后高迁移率族蛋白B1的临床相关性研究

目的 研究创伤性急性肺损伤(acute lung injury,ALI)后血清高迁移率蛋白-1(high mobility group box 1 protein,HMGB -1)的水平变化,探讨其与MODS、急性生理学与慢性健康状况Ⅱ(acute physiology and chronic health evaluation,APACHEⅡ)评分的相关性,以及其对MODS发生率和死亡率的预警作用. 方法 测定10例正常人与40例ALI患者伤后第1,4,7天的血清HMGB -1水平.根据MODS的诊断标准,将损伤组分为两组:MODS组13例,非MODS组27例.同时评定其MODS、APACHEⅡ分值. 结果 组间比较:非MODS组第1,4,7天HMGB -1水平的表达均高于MODS组(P＜0.05)；非MODS组HMGB -1水平的表达高于正常对照组,但低于MODS组.组内比较:非MODS组第4天HMGB -1水平的表达明显高于第1天(P＜0.01),第7天较第4天明显降低(P＜0.01),甚至低于第1天.MODS组血清HMGB -1水平的表达显著升高,并延续数天,第7天较第4天有所降低,但仍高于第1天.伤后第1,4,7天MODS评分随HMGB -1水平的动态变化差异明显.伤后第1,4,7天APACHEⅡ评分比较,差异明显.相关性分析显示,HMGB -1水平的表达与MODS评分、APACHEⅡ评分显著相关. 结论 (1)HMGB -1在ALI患者中呈高表达,其作为晚期炎症介质参与炎性反应往往升高较晚,且持续时间较长.(2)HMGB -1水平变化与并发MODS密切相关.(3)常规检测血清HMGB -1水平并联合评定MODS、APACHEⅡ评分有助于对创伤后脏器功能不全的预测.

Clinical correlative study on high mobility group box 1 protein after traumatic acute lung injury

Objective To study the changes of serum high mobility group box 1 protein ( HMGB-1 ) in patients with traumatic acute lung injury (ALI) and determine its correlations with MODS,acute physiology and chronic health evaluation ( APACHE Ⅱ ) scores and whether it can predict the incidence of MODS and mortality.Methods Forty cases of ALI were divided into MODS group (n =13) and nonMODS group (n =27) according to the MODS evaluation standard.The serum HMGB-1 was determined in the control group ( 10 healthy persons) and the MODS and non-MODS groups at days 1,4 and 7.The MODS and APACHE Ⅱ scores were also evaluated.Results Between the groups,the HMGB-1 level at days 1,4 and 7 in non-MODS group was higher than that in the control group,while lower than that in MODS group (P＜0.05).Within the non-MODS group,the expression of HMGB-1 showed a high level at day 4 compared with that at day 1 ( P ＜0.01 ) ; the HMGB-1 showed a low level at day 7 with clinical symptom improvement compared with that at day 4,and was even lower than that at day 1 ( P ＜ 0.01 ).Within the MODS group,the serum HMGB-1 level was significantly increased,and continued for several days; the HMGB-1 was decreased slightly at day 7 in comparison with that at day 4,but was still higher than that at day 1.The difference of MODS and APACHE Ⅱ score was significant,with the dynamic change of HMGB-1 level at days 1,4 and 7 after traumatic ALI.The correlative analysis showed that HMGB-1 expression level was remarkably related with MODS score and APACHE Ⅱ score.Conclusions HMGB-1 shows a high expression in patients with traumatic ALI.As a late mediator of inflammation,HMGB-1 usually increases relatively late and lasts for a long duration.HMGB-I level and concurrency MODS are closely related.Routine test of serum HMGB-1 level and joint assessment of MODS and APACHE Ⅱ score are contributive to the prediction of organ dysfunction after traumatic ALI.