严重烧伤后高迁移率族蛋白B1的变化及其与脓毒症的关系

目的动态观察严重烧伤患者血浆中高迁移率族蛋白B1(HMGB1)水平的变化并探讨其与脓毒症及内毒素血症的关系。方法25例烧伤总体表面积大于30%患者,根据是否并发脓毒症分组(脓毒症组14例、非脓毒症组11例),采用酶联免疫吸附实验及改良基质显色法鲎实验分别检测患者伤后1、3、5、7、14、21、28d血浆HMGB1及内毒素含量的变化。结果严重烧伤患者伤后第1天血浆中HMGB1含量显著升高,其中伤后第7、21、28天脓毒症组HMGB1含量显著高于非脓毒症组(P<0.05)。脓毒症患者存活组伤后第3、21天HMGB1含量显著低于非存活组(P<0.05,P<0.01),血浆中HMGB1含量与是否易并发脓毒症有关,但与烧伤总体表面积无相关性(P>0.05)。伤后第3、5、7、21天血浆HMGB1与内毒素含量呈显著正相关(P<0.05,P<0.01)。结论HMGB1作为重要的晚期炎症介质参与严重烧伤后脓毒症的病理生理过程,其诱生与内毒素刺激密切相关,动态观察其水平有助于烧伤后病程监测及患者预后判断。

Changes in Plasma High Mobility Group Box-1 Protein Levels and Its Relationship with Sepsis in Severely Burned Patients

Objective To investigate the significance of changes in plasma high mobility group box-1 protein(HMGB1)levels and its relationship with sepsis and endotoxemia in severely burned patients.Methods Totally 25 large area burned patients(>30% total body surface area)were included in this study,and 8 healthy volunteers served as normal controls.The plasma levels of HMGB1 were measured by ELISA,and endotoxin concentrations was determined by the modified chromogenic limulus amebocyte lysate(LAL)assay on postburn days 1,3,5,7,14,21,and 28.Results The plasma HMGB1 levels were markedly elevated on postburn day 1 in severely burned patients,and they were significantly higher in septic patients than those without sepsis on days 7,21,and 28 after burns(P<0.05).Among septic patients,plasma HMGB1 levels in the survival group were significantly lower than those with fatal outcome on days 3 and 21(P<0.05,P<0.01).No significant correlations were found between HMGB1 levels and the sizes of total body surface area(P>0.05).In addition,the plasma HMGB1 levels were positively correlated with endotoxin concentrations on days 3,5,7,21 after major burns(P<0.05,P<0.01).Conclusions HMGB1,as an important late mediators of inflammation,may be involved in the development of sepsis following extensive burns,and it can be markedly induced by endotoxemia secondary to acute insults.Dynamic measurements of circulating HMGB1 levels should be helpful to monitor the disease course and judge the prognosis of burned patients.