手术应激影响患儿血浆高迁移家族蛋白1的表达及临床意义  

The expression and clinical significance of high-mobility group box 1 in children under surgical stress

作　　者：许云云[1,2] 李嫣[1] 张奇[3] 向永军 唐汝泽 汪健[3] 黄洁[4] XU Yunyun LI Yan ZHANG Qi XIANG Yongjun TANG Ruze WANG Jian HUANG Jie(Institute of Pediatrics, Affiliated Children＇s Hospital, Soochow University, Suzhou 215025 The Stem Cell Key Laboratory of Jiangsu Province, Soochow University Department of Pediatric Surgery Department of Pediatric Cardiology, Affiliated Children＇s Hospital, Soochow University)

机构地区：[1]苏州大学附属儿童医院儿科研究所,苏州215025 [2]苏州大学江苏省干细胞重点实验室苏州大学附属儿童医院 [3]苏州大学江苏省干细胞重点实验室苏州大学附属儿童医院外科 [4]苏州大学江苏省干细胞重点实验室苏州大学附属儿童医院心内科

出　　处：《南通大学学报（医学版）》2016年第5期444-447,共4页Journal of Nantong University(Medical sciences)

基　　金：江苏省教育厅面上项目(15KJB320013)

摘　　要：目的:探讨手术患儿血浆中高迁移家族蛋白1(high-mobility group box 1,HMGB1)与手术应激程度、手术方式及术后并发症的关系,为临床预防和治疗术后感染提供新思路。方法:2013年6月—2014年12月苏州大学附属儿童医院外科病房收治的需经手术治疗的患儿53例,根据其临床表现和实验室结果分为:中度应激组与重度应激组、普外组与心胸外组、术后并发症组与无并发症组。收集术前(PRE)、术后即刻(POD0)、术后1 d(POD1)、术后3 d(POD3)和术后7 d(POD7)的血标本,酶联免疫吸附法(enzyme-linked immunoabsorbent assay,ELISA)检测各组患儿血浆中HMGB1和白细胞介素6(interleukin 6,IL-6)的表达水平,分析HMGB1变化与手术应激程度、手术方式及手术后并发症之间的关系。结果:与早期炎症因子IL-6相比,炎症因子HMGB1在患儿血浆中的表达区间更为广谱;手术应激程度和手术方式均影响手术患儿血浆中HMGB1的表达水平(P<0.05)。患儿血浆中HMGB1的表达与手术应激程度(尤其是内脏损伤程度)、手术方式、性别相关(P<0.05),但与术后并发症不相关(P>0.05)。结论:手术应激程度和手术方式均是导致HMGB1异常表达的关键因素,为此降低手术应激程度或优化手术方式将有助于适时抑制HMGB1的过度活化,从而减少并发症的发生。Objective： To examine correlations of plasma high-mobility group box 1（HMGB1） with the severity of surgical stress,surgical approach and postoperative complications in children subjected to surgery, and develop new thinking on the prevention and treatment of postoperative complications. Methods： A total of 53 pediatric patients admitted to Children＇s Hospital Affiliated to Soochow University between June 2013 and December 2014 were divided into moderate and severe stress groups,general and cardiothoracic surgery groups, and postoperative-complication and non-complication groups, in accordance with their clinical symptoms and laboratory findings. Peripheral blood samples were collected Plasma HMGB1 levels were measured at following time points： pre-operation（PRE）, immediately postoperative（POD0）, 1 day（POD1）, 3 days（POD3）, and 7days（POD7） post-operation. Enzyme-linked immunoabsorbent assay（ELISA） was used to measure the expression of plasma HMGB1 and interleukin 6（IL-6）. Correlations between plasma HMGB1 and surgical stress, surgical approach, and postoperative complications were analyzed. Results： HMGB1 was more widely expressed than IL-6. Plasma HMGB1 levels in pediatric patients were affected by surgical stress and surgical approach（P〈0.05）. The expression of plasma HMGB1 in pediatric patients was correlated with the severity of surgical stress（visceral injuries in particular）, surgical approach and gender（P〈0.05）,but was not correlated with postoperative complications（P〉0.05）. Conclusion： The severity of surgical stress and surgical approach are key factors leading to the abnormal expression of plasma HMGB1, so reducing the severity of surgical stress or optimizing surgical approach will contribute to the timely suppression of the overactivity of plasma HMGB1 and thus the reduced occurrence of complications.

关 键 词：高迁移家族蛋白1 手术应激程度 手术方式 术后并发症 儿童 

分 类 号：R726.1[医药卫生—儿科]