高迁移率族蛋白-1浓度变化与脓毒症预后的关系

目的 探讨脓毒症患者血浆高迁移率族蛋白-1(HMGB-1)质量浓度变化对预测28d生存情况的临床价值.方法 采用的瞻性设计,入选广东省人民医院ICU 2008年6月至2009年9月脓毒症非多器官功能障碍综合征患者56例,排除:年龄＜18岁；慢性疾病终末期；入选3d内2个或2个以上器官功能障碍；急性胰腺炎,但明确无感染者；因为其他医学原因,预测不可能生存超过28 d的患者.45例患者最终纳入统计.患者于发病后第0,1,3,7天采外周静脉血,离心取血浆酶联免疫吸附法检测HMGB-1浓度,前7d每天进行感染相关器官功能衰竭评分(SOFA)、急性生理与慢性健康状况评分Ⅱ( APACHEⅡ),并随访28 d临床结局.根据28 d生存情况将患者分为存活组和死亡组,采用t检验比较两组间血浆HMGB-1浓度及其变化的差异,Spearman秩相关分析血浆HMGB-1质量浓度及其变化与SOFA、APACHEⅡ评分的关系,接收者工作特征曲线(ROC曲线)下面积法检验相关指标的预测效力.结果 死亡组、存活组第0,1,3,7天血浆HMGB-1质量质量浓度质鼍浓度差异无统计学意义(P＞0.05)；死亡组血浆HMGB-1第3天与第0天差值显著低于存活组；第3天与第0天m浆HMGB-1差值预测脓毒症患者28 d生存的曲线下面积为0.868 ±0.061(P=0.000,95％ CI:0.748～0.988)；最佳截断点2.72 ng/mL,此时灵敏度为81.8％、特异度86.7％；血浆HMGB-I第3天与第0天差值与第1,2,3,4天SOFA评分之间呈显著负相关(P＜0.05).结论 脓毒症患者血浆HMGB-1下降可以预测28 d生存情况,早期监测其动态变化有助于预测脓毒症患者预后.

Significance of plasma high mobility group protein -1 levels in the prognosis of patients with sepsis

Objective To investigate the clinical value of plasma high mobility group protein - 1 levels in predicting 28 - day prognosis of patients with sepsis.Methods From June 2008 through September 2009,56 sepsis patients without muhiple organ dysfunction syndromes were included in this prospective study.Patients with age under 18 years old,final stage of chronic diseases,organ dysfunction involved in two or more organs occurred within 3 days and acute pancreatitis with expected survival within 28 days due to medical reasons rather than infection were excluded.Finally,45 patients were included in the further analysis.Peripheral blood samples were collected just on the day of onset and 1 d,3 d and 7 days after onset of disease.HMGB-1 levels in the supernatant after centrifuge were measured by using ELISA.Sequential organ failure assessment (SOFA) scores and APACHE Ⅱ scores were recorded everyday.Patients' prognoses were assessed during the 28 - day follow - up period.According to the outcomes of patients within the 28 - day period,the patients were divided into survival group and non - survival group.HMGB-t levels between the two groups were compared by Student' s t - test.Spearman rank correlation was used to analyze the correlation between HMGB-1 levels and SOFA as well as APACHE Ⅱ.The validity of predicting patients' survival within the 28 - day period with some selected variables was verified by receiver operating characteristic curves (ROC curves).Results There was no significant difference in plasma HMGB-1 levels assayed at all intervals between the survival group and non - survival group ( all P ＞ 0.05).The difference in the level of HMGB-1 in the plasma of patients in non - survival group between the 3rd day after onset and the day of onset (△3 -0 HMGB-1 ) HMGB-1 ) was found and this difference was significantly lower than that of survival group.ROC curves area of this difference ( △ 3 -0 HMGB-1 ) for predicting 28 - day survival was 0.868 ± 0.061 (P =0.000,95％ CI0.748 ～ 0.988 ).The optimal cut -off point was 2.72 ng/mL,and the sensitivity and specificity were 81.8％ and 86.7％,respectively at this point.The △ 3 -0 HMGB-1 ) HMGB-1 was negatively correlative to SOFA on the 1st,2nd,3rd and 4th days after onset ( all P ＜ 0.01 ).Conclusions The variable of decrease in HMGB-1 levels can be served as one of the indicators to predict 28 - day survival in patients with sepsis.Monitoring the dynamic changes of HMGB-1 in the early stage may be useful to predict the outcome of septic patients