血清高迁移率族蛋白B1、调节性T细胞(Treg)水平对脓毒症患者肠屏障状况及临床预后的影响  

Impact of high-mobility group box 1 protein and regulatory T cells on intestinal barrier status and clinical prognosis of patients with sepsis

作　　者：杨静[1] 何浩[1] 谭波 陈丽[1] YANG Jing;HE Hao;TAN Bo;CHEN Li(Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan 637000,China)

机构地区：[1]川北医学院附属医院重症医学科,四川南充637000

出　　处：《中华医院感染学杂志》2020年第1期54-57,共4页Chinese Journal of Nosocomiology

摘　　要：目的探究脓毒症患者血液中炎症和免疫指标水平对肠屏障状况及临床预后的影响。方法回顾性分析2015年9月-2018年9月川北医学院附属医院ICU收治的82例脓毒症患者的临床资料,根据患者急性生理与慢性健康评分(APACHEⅡ)及脓毒症临床症状评分指南,分为轻中度脓毒症组43例和重度脓毒症组39例。采集两组患者血样本,测定血清炎症因子高迁移率族蛋白B1(high mobility group protein,HMGB1)、白细胞介素-6(Interleukin-6,IL-6)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)和免疫指标调节性T细胞(Treg)、辅助性T细胞(TH)水平,以及反映患者肠道屏障状况的二胺氧化酶(Diamine Oxidase,DAO)、D-乳酸(D-lactic acid,D-LAC)及肠脂肪酸结合蛋白(Intestinal Fatty Acid Binding Protein,IFABP)含量,并分析上述指标与患者预后的关系。结果轻中度脓毒症患者组的HMGB1(23.21±4.23,ng/ml)、Treg(3.62±1.07,%)、IL-6(86.67±21.38,pg/ml)、TH(1.54±0.47,%)水平均低于重度脓毒症患者组,TNF-α(0.36±0.05,ng/L)水平高于重度脓毒症患者组(P<0.05)。轻中度脓毒症患者组的肠屏障功能指标DAO(17.36±1.86,mg/ml)、D-LAC(0.22±0.04,mmol/ml)、IFABP(21.38±3.62,pg/L)水平均低于重度脓毒症患者组(P<0.05)。存活组患者的HMGB1(24.12±4.36,ng/ml)、Treg(3.78±1.13,%)、IL-6(89.36±25.73,pg/ml)、TH(1.68±0.52,%)水平均低于死亡组,TNF-α(0.38±0.07,ng/L)水平高于死亡组(P<0.05)。多因素分析结果HMGB1、Treg、IL-6、TNF-α、TH指标与治疗后患者结局具有相关性。结论血清高迁移率族蛋白B1、调节性T细胞、IL-6、TNF-α、TH水平均与脓毒症患者肠屏障功能具有相关性,并影响患者预后,对患者病情具有一定的诊断意义。OBJECTIVE To explore the impact of serum inflammatory and immunological indexes on intestinal barrier status and clinical prognosis of the patients with sepsis. METHODS The clinical data of 82 patients with sepsis who were treated in the Affiliated Hospital of North Sichuan Medical College from Sep 2015 to Sep 2018 were retrospectively analyzed, the enrolled patients were divided into the mild and moderate sepsis group with 43 cases and the severe sepsis group with 39 cases according to acute physiology and chronic health evaluation(APACHE) II score and scoring guidelines for clinical symptoms of sepsis.The blood specimens were collected from the two groups of patients so as to determine the levels of high-mobility group box 1(HMGB1) protein, interleukin-6(IL-6), tumor necrosis factor-α(TNF-α) and immunological indexes regulatory T cells(Treg) and helper T cells(TH) as well as diamine oxidase(DAO), D-lactic acid(D-LAC) and intestinal fatty acid binding protein(IFABP), which could reflect the intestinal barrier status of the patients.The correlation between the above indexes and the prognosis was observed. RESULTS The levels of HMGB1, Treg, IL-6 and TH of the mild and moderate sepsis group were respectively(23.21±4.23,ng/ml),(3.62±1.07,%),(86.67±21.38,pg/ml) and(1.54±0.47,%), significantly lower than those of the severe sepsis group;the TNF-α level of the mild and moderate group was(0.36±0.05,ng/L), significantly higher than that of the severe sepsis group(P<0.05).The levels of intestinal barrier function indexes DAO, D-LAC and IFABP of the mild and moderate sepsis group were respectively(17.36±1.86,mg/ml),(0.22±0.04,mmol/ml) and(21.38±3.62,pg/L), significantly lower than those of the severe sepsis group(P<0.05).The levels of HMGB1, Treg, IL-6 and TH of the survival group were respectively(24.12±4.36,ng/ml),(3.78±1.13,%),(89.36±25.73,pg/ml) and(1.68±0.52,%), significantly lower than those of the death group, while the TNF-α level of the mild and moderate sepsis group was(0.38±0.07,ng/L), significa

关 键 词：脓毒症 肠屏障 多因素分析 临床预后 

分 类 号：R631[医药卫生—外科学]