【作者】 江稳强； 黄伟平； 陈纯波； 朱高峰； 蒋鑫； 王桥生； 陈柳勤； 曾红科； 高向民；

【Author】 JIANG Wen-qiang,HUANG Wei-ping,CHEN Chun-bo*,ZHU Gao-feng,JIANG Xin,WANG Qiao-sheng,CHEN Liuqing,ZENG Hong-ke,GAO Xiang-min.*Department of Emergency & Critical Care Medcine,Guangdong General Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China

【机构】 广东省人民医院(广东省医学科学院)急危重症医学部； 南方医科大学研究生学院； 南华大学附属第一医院； 广东省人民医院(广东省医学科学院)检验科； 广东省人民医院(广东省医学科学院)流行病研究室；

【摘要】 目的:探讨脓毒症患者血浆高迁移率族蛋白-1(HMGB-1)浓度变化对预测28d生存情况的临床价值。方法:采用前瞻性设计,入选我院ICU2008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28d的患者,45例患者最终纳入统计。患者于发病后第0、1、3、7d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28d临床结局。根据28d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、7d血浆HMGB-1浓度差异无统计学意义(P均>0.05);死亡组血浆HMGB-1第3d与第0d差值显著低于存活组;第3d与第0d血浆HMGB-1差值预测脓毒症患者28d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2.72ng/mL,此时灵敏度为81.8%、特异度86.7%;血浆HMGB-1第3d与第0d差值与第1、2、3、4dSOFA评分之间呈显著负相关(P均<0.05)。结论:脓毒症患者血浆HMGB-1下降可以预测28d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。更多还原

【Abstract】 Objective:To investigate the clinical value of plasma high mobility group protein-1 levels in predicting 28-day prognosis in patients with sepsis.Methods:From June,2008to September,2009,56 sepsis patients without multiple organ dysfunction syndromes were included in a prospective study.Patients were excluded if age less than 18 years old,in final stage of chronic diseases,suffering from two or more organs dysfunction within 3 days,acute pancreatitis without infection,due to other medical reasons whose expected survival was less than 28 days.Finally,45 patients were included in the further analysis.Peripheral blood samples were collected on days 0,1,3,7.HMGB-1 levels were measured by ELISA in the supernatant after centrifuge.SOFA scores and APACHE Ⅱ scores were recorded everyday.Patients’ prognoses were assessed during the 28-day follow-up period.According to the survival condition within the 28-day period,the patients were divided into survival group and non-survival group.HMGB-1 levels between the two groups were compared by Student’s t-test.Spearman rank correlation is used to analyze the correlation between HMGB-1 levels and SOFA as well as APACHE Ⅱ.The effect on predicting survival within the 28-day period in the selected parameter by receiver operating characteristic curves(ROC curves).Results:There was no significant difference in plasma HMGB-1 levels on day 0,1,3,7 between the survival group and non-survival group(P all>0.05).The difference in the concentration of HMGB-1 between 3 d and 0 d(Δ3-0HMGB-1) in plasma of the non-survival group was significantly lower than that of survival group.ROC curves area of Δ3-0 HMGB-1 is 0.868±0.061(P=0.000,95% CI 0.748～0.988) for predicting 28-day survival.The optimal cut-off point was 2.72 ng/mL,and the sensitivity and specificity were 81.8% and 86.7% at this time,respectively.Δ3-0HMGB-1 is negatively correlative to SOFA on days 1,2,3,4(P all<0.01).Conclusion:Decreased 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 used to predict septic patients’ prognosis.更多还原