血清HMGB1和CXCL16对脓毒症患者认知功能障碍恢复及短期生活质量评价的临床意义  

The Clinical Significance of Serum HMGB1 and CXCL16 Expressions in Sepsis Patients for Evaluation of Cognitive Dysfunction Recovery and Short-term Quality of Life

作　　者：李萍[1] 杨秀红[1] 文进[1] 聂玉琴[1] LI Ping;YANG Xiuhong;WEN Jin;NIE Yuqin(Department of Critical Care Medicine,the Second Affiliated Hospital,Urumchi 830028,China)

机构地区：[1]新疆医科大学第二附属院重症医学二科,新疆乌鲁木齐830028

出　　处：《标记免疫分析与临床》2020年第4期631-634,639,共5页Labeled Immunoassays and Clinical Medicine

基　　金：新疆维吾尔自治区自然科学基金(编号:2017D01C242)。

摘　　要：目的探讨血清高迁移率族蛋白B1(HMGB1)和趋化因子CXCL16的表达在脓毒症继发认知功能障碍患者的认知功能恢复和短期生活质量评价中的临床意义。方法选择2017年8月至2018年8月入我院诊断脓毒症患者共112例,采用ELISA法检测患者治疗前、治疗28 d、随访6个月和12个月血清HMGB1和CXCL16水平,采用简易智能精神检查量表(MMSE)评估治疗28 d、随访6个月和12个月的认知功能障碍发生率,随访12个月认知功能恢复和生活质量(SF-36)评分。结果112例患者治疗28 d、随访6个月和12个月血清HMGB1和CXCL16水平逐渐下降(P<0.05),MMSE评分逐渐降低,认知功能障碍发生率增加(P<0.05)。随访12个月共罹患认知功能障碍患者40例(35.7%),认知功能障碍患者血清HMGB1和CXCL16水平明显高于认知功能正常者(P<0.05)。40例患者中认知功能恢复22例(55.0%),认知功能恢复者血清HMGB1和CXCL16水平明显低于未恢复者(P<0.05)。认知功能未恢复者SF-36评分明显低于恢复者(P<0.05),恢复者与未发生认知功能障碍者比较差异无统计学意义(P>0.05)。结论脓毒症康复期可继发认知功能障碍,可能与血清HMGB1和CXCL16表达水平升高有关,认知功能恢复后表达水平可下降,也可能影响短期随访生活质量。血清HMGB1和CXCL16水平可作为评估脓毒症患者短期认知功能康复和生活质量的重要指标。Objective To explore clinical significance of serum high mobility group box1(HMGB1)and chemokine CXCL16 levels in sepsis patients for evaluation of secondary cognitive dysfunction,function recovery and short-term quality of life.Methods A total of 112 sepsis patients from August,2017 to August,2018 were enrolled for the study.We measured serum levels of HMGB1 and CXCL16 with ELISA before treatment,28 days after treatment,6 months and 12 months during follow-up.The incidence of cognitive impairment was assessed with MMSE 28 days after treatment,6 months and 12 months during follow-up.The cognitive function recovery and quality of life(SF-36)score were evaluated 12 months during follow-up.Results The serum levels of HMGB1 and CXCL1628 days after treatment,6 months and 12 months during follow-up among 112 patients were gradually decreasing(P<0.05).MMSE scores were decreasing,while rates of cognitive dysfunction were increasing(P<0.05).There were up to 40 of cognitive dysfunction 12 months during follow-up(35.7%),of which 22 cases achieved function recovery(55.0%).The serum levels of HMGB1 and CXCL16 in patients with cognitive dysfunction were significantly higher than non-cognitive dysfunction(P<0.05),and their function recovery were lower than non-function recovery(P<0.05).The SF-36 score in non-function recovery was less than function recovery(P<0.05),while no difference between function recovery and non-cognitive dysfunction(P>0.05).Conclusion Secondary cognitive impairment may occur during sepsis rehabilitation,which could be related to higher expressions of serum HMGB1 and CXCL16.The serum HMGB1 and CXCL16 levels may decrease after recovery of cognitive function,and may also affect short-term quality of life during follow-up.Serum levels of HMGB1 and CXCL16 can be used as important indicators for evaluating short-term cognitive rehabilitation and quality of life in sepsis patients.

关 键 词：高迁移率族蛋白B1 趋化因子CXCL16 脓毒症 认知功能障碍 生活质量 

分 类 号：R446.1[医药卫生—诊断学]