脓毒症休克患者血浆高迁移率族蛋白B1表达水平动态变化及临床意义

目的探讨脓毒症休克患者高迁移率族蛋白B1(HMGB1)动态变化与其预后之间的关系。方法收集2014年3月至2016年3月该院ICU收治的98例脓毒症患者为研究对象,根据脓毒症患者入院时是否发生休克分为休克组48例和对照组50例,分别对比两组患者入院后28d内的HMGB1水平及急性生理与慢性健康评分系统Ⅱ(APACHEⅡ)评分变化情况;根据治疗前HMGB1水平将休克组分为A组(HMGB1≤35pg/mL)30例、B组(HMGB135pg/mL)18例,自入院当日起对两组患者观察3月,对比治疗后7d两组患者的APACHEⅡ评分、中心静脉血氧饱和度(ScvO2)、乳酸浓度、乳酸清除率,住院期间ICU机械通气使用率及3月内存活率等指标。结果入院时,休克组、对照组患者的HMGB1水平及APACHEⅡ评分情况比较差异无统计学意义(P0.05);入院后第7、14、21、28天休克组的HMGB1水平及APACHEⅡ评分显著高于对照组,差异有统计学意义(P0.05);治疗后7d,A组的APACHEⅡ评分、乳酸清除率平均值、ScvO2均显著高于B组,差异有统计学意义(P0.05);A组患者3月内存活率也明显高于B组,差异有统计学意义(P0.05);A组治疗后7d乳酸浓度、住院期间ICU机械通气使用率则明显低于B组,差异有统计学意义(P0.05)。结论 HMGB1水平变化与脓毒症休克患者预后具有较强相关性,HMGB1水平越高,脓毒症休克患者的预后越差,HMGB1可作为脓毒症病情变化的重要监测指标,值得临床检验重视。

Dynamic expression level of plasma HMGB 1 and clinical significance in patients with sepsis shock

Objective To explore the dynamic change of high mobility group box-1(HMGB1) expression in sepsis shock patients and its relationship with prognosis.Methods A total of 98 patients with septic shock in ICU from March 2014 to March 2016 were collected as the research subjects and divided into the shock group (48 cases) and control group(50 cases) according to whether de-veloping shock at admission.The HMGB1 levels and APACHE Ⅱ scores change within 28 d after admission were compared be-tween the two groups ;the shock group was divided into the group A (HMGB1≤35 pg/mL ,30 cases) ,B(HMGB1>35 pg/mL ,18 cases) according to the HMGB1 level before treatment ,the two groups were observed for 3 months from the day admitted to hospi-tal.The APACHEⅡ score ,ScvO2 ,lactic acid concentration and lactic acid clearance rate after 7 d treatment ,ICU mechanical venti-lation use rate and survival rate within 3 months were compared between the two groups.Results The HMGB1 level and A-PACHEⅡ scores before admission had no statistical difference between the shock group and control group (P>0.05);the HMGB1 and APACHEⅡ scores on 7 ,14 ,21 ,28 d after admission in the shock group were significantly higher than those in the control group ,the difference was statistically significant(P<0.05);the APACHEⅡ score ,mean lactic acid clearance rate and ScvO2 after 7 d treatment in the group A were significantly higher than those in the group B ,the difference was statistically significant (P<0.05) ,the survival rate within 3 months after admission in the group A was also significantly higher than that in the group B ,the difference was statistically significant (P<0.05) ,while the lactic acid concentration and ICU mechanical ventilation use rate after 7 d treatment in the group A were significantly lower than those in the group B with statistical difference (P<0.05).Conclusion The HMGB1 level change has a strong correlation with the prognosis ,the higher the HMGB1 level ,the worse the prognosis of patients with septic shock ,HMGB1 can be used as an important indicator of monitoring disease condition changes in sepsis ,which is worthy of attention in clinical laboratory.