重度脓毒症患者血浆高迁移率族蛋白-1水平及其与多器官功能障碍综合征严重程度的相关性研究  

Study on the changes of plasma high mobility group box - 1 protein and its relationships with multiple organ dysfunction syndrome in severe sepsis

作　　者：李轶男[1] 周立新[1] 毛克江[1] 温伟标[1] 方滨[1] 誉铁鸥[1] 邹毅成[1] 黎文研[1] 黎昌[1] 

机构地区：[1]佛山市第一人民医院ICU,广东528000

出　　处：《中国急救医学》2009年第1期32-35,共4页Chinese Journal of Critical Care Medicine

基　　金：广东省科技计划项目（No.2004836001005）;佛山市重点科技攻关项目（No.04080081）

摘　　要：目的研究重度脓毒症患者血浆高迁移率族蛋白-1（high mobility group box-1，HMGB-1）水平的变化及其与多器官功能障碍综合征（MODS）严重程度的相关性。方法本研究采用前瞻方法，选择ICU确诊为重度脓毒症的患者42例，监测患者第1、4及7天血浆HMGB-1水平，记录同期患者APACHEⅡ评分、Marshall评分、SOFA评分和28d预后。结果28d内死亡16例，28d死亡率为38．1％。在观察时段内，重度脓毒症患者血浆HMGB-1水平逐渐下降，差异有统计学意义（P〈0．05），但一直明显高于正常对照组（P〈0．01）。死亡组血浆HMGB-1水平明显高于存活组（P〈0．05或P〈0．001），虽然在观察时段HMGB-1水平呈逐渐下降趋势，但差异无统计学意义，且持续处于较高水平的状态；存活组血浆HMGB-1水平逐渐降低（P〈0．05），第7天与第1天比较差异有统计学意义（P〈0．05）。Pearson相关分析显示，全程血浆HMGB-1水平与Marshall评分和SOFA评分均呈显著正相关（r=0．234，P〈0．05；r=0．217，P〈0．05）。结论重度脓毒症患者血浆HMGB-1水平明显高于正常对照组，HMGB-1水平持续升高者病死率高，且血浆HMGB-1水平与患者器官功能障碍严重程度显著相关。Objective To explore the changes of plasma high mobility group box - 1 （ HMGB - 1 ） protein and its relationship with multiple organ dysfunction syndrome in severe sepsis. Methods Forty - two patients definitely diagnosed as severe sepsis in intensive care unit （ICU） were included. Plasma HMGB - 1 levels were detected on the first, the 4th and the 7th day, and APACHE Ⅱ , Marshall scores, SOFA scores, 28 - day prognosis were evaluated. Results 16 patients died within 28 days and the mortality was 38.1%. The levels of HMGB - 1 were decreased in severe sepsis step by step （P =0. 021 ） and which were significantly higher than those in healthy controls （ P 〈 0.01 ）. The plasma levels of HMGB - 1 were significantly higher in nonsurvivals at all time points than those in survivals （ P 〈 0. 05 or P 〈0. 001）. In the nonsurvivals, the levels of HMGB -1 decreased gradually and kept high level. In the survivals, the levels of HMGB - 1 decreased gradually and significantly （ P 〈 0.05 ） and were significantly lower on the 7th day than those on the first day （ P 〈 0.05 ）. The levels of plasma HMGB - 1 throughout the observing time were significantly positive correlations with Marshall scores and SOFA score （ r = 0. 234, P〈0. 05;r =0. 217,P〈0.05）. Conclusion The levels of plasma HMGB -1 in severe sepsis were significantly higher than those in healthy controls, and persistently increased HMGB - 1 levels predict higher mortality. The levels of HMGB - 1 significantly correlated with the severity of organ dysfunction.

关 键 词：重度脓毒症 高迁移率族蛋白-1 多器官功能障碍综合征 SOFA评分 

分 类 号：R5[医药卫生—内科学]