HMGB1-Th17/IL-17炎症轴在重症肺炎中的作用及其临床意义  

The role of HMGB1-Th17/IL-17 inflammation axis in severe pneumonia and its clinical significance

作　　者：杨志明[1] 陈鸣娣 刘晓月 邹天士[1] 桑喜梅[4] 林颖[1] YANG Zhiming;CHEN Mingdi;LIU Xiaoyue;ZOU Tianshi;SANG Ximei;LIN Ying(Department of Respiratory Medicine,First People's Hospital of Zhaoqing in Guangdong Province,Zhaoqing 526000,China;Department of Critical Care Medicine,Second Affiliated Hospital of Guangdong Medical University,Zhanjiang524000,China;Science Education Museum of Guangdong Province Geological Bureau(Guangdi Geological Sanatorium),Zhaoqing 526000,China;Coronary Care Unit,First People's Hospital of Zhaoqing in Guangdong Province,Zhaoqing 526000,China)

机构地区：[1]广东省肇庆市第一人民医院呼吸内科,广东肇庆526000 [2]广东医科大学附属第二医院重症医学科,广东湛江524000 [3]广东省地质局科普教育馆(广地地质疗养院),广东肇庆526000 [4]广东省肇庆市第一人民医院CCU,广东肇庆526000

出　　处：《中国现代医生》2020年第21期26-30,共5页China Modern Doctor

基　　金：广东省肇庆市科技创新指导类项目(201804030711)。

摘　　要：目的探讨HMGB1-Th17/IL-17炎症轴在重症肺炎中的作用及其临床价值。方法选取2018年6月~2019年3月在广东医科大学附属第二医院重症医学科收治的重症肺炎患者24例(重症肺炎组),其中15例患者病情好转(好转组),选取广地地质疗养院体检中心健康体检者19例作为对照组,记录重症肺炎组患者收治ICU第1天及其转出病房当天的急性生理学与慢性健康状况(APACHEⅡ)评分,并检测其及对照组体检当天的HMGB1、IL-17表达水平,比较各组HMGB1、IL-17水平的差异,分析HMGB1、IL-17与APACHEⅡ评分三者之间的相关性。结果重症肺炎组患者血浆HMGB1、IL-17表达水平较好转组的及对照组的均高,差异有统计学意义(P<0.05),重症肺炎组患者血浆HMGB1与IL-17水平呈正相关(r=0.788,P<0.05),重症肺炎组患者血浆HMGB1、IL-17水平与APACHEⅡ评分呈正相关(r分别为0.964,0.771,P均<0.05)。好转组患者血浆HMGB1、IL-17水平与APACHEⅡ评分无明显相关性(r分别为0.181,0.403,P值分别为0.519,0.137)。好转组患者血浆HMGB1、IL-17水平与对照组的比较,差异有统计学意义(P<0.05)。结论HMGB1-Th17/IL-17炎症轴在重症肺炎的发生发展中起重要作用,它可作为治疗重症肺炎的潜在切入点。Objective To explore the role and clinical value of HMGB1-Th17/IL-17 inflammation axis in severe pneumonia.Methods Twenty-four patients with severe pneumonia admitted to the Department of Intensive Medicine of the Second Affiliated Hospital of Guangdong Medical University from June 2018 to March 2019 were selected as severe pneumonia group.Among them,15 patients who got better were set as the improvement group.A total of 19 healthy patients from Physical Examination Center in Guangdi Geological Sanatorium were served as the control group.The acute physiology and chronic health status(APACHEⅡ)scores of the severe pneumonia group on the first day of ICU admission and the day they were transferred out of the ward were recorded.The expression levels of HMGB1 and IL-17 of the severe pneumonia group and the control group on the day of the physical examination were detected.The difference in the levels of HMGB1 and IL-17 between each group were compared.And the correlation between the HMGB1,IL-17 and APACHEⅡscores was analyzed.Results The plasma HMGB1 and IL-17 expressions in the severe pneumonia group were higher than those in the improvement group and the control group,and the difference was statistically significant(P<0.05).In the severe pneumonia group,the plasma HMGB1 and IL-17 was positively correlated(r=0.788,P<0.05).And the levels of plasma HMGB1 and IL-17 of the severe pneumonia group were positively correlated with the APACHEⅡscore(r was 0.964,0.771,P<0.05).There was no significant correlation of HMGB1,IL-17 and the APACHEⅡscore in the improvement group(r were 0.181 and 0.403,respectively,and P was 0.519 and 0.137,respectively).There were statistically significant differences in levels of plasma HMGB1 and IL-17 between the improvement group and the control group(P<0.05).Conclusion The HMGB1-Th17/IL-17 inflammation axis plays an important role in the development of severe pneumonia,and it can be used as a potential entry point for the treatment of severe pneumonia.

关 键 词：重症肺炎 高迁移率族蛋白B1 白介素-17 APACHEⅡ评分 

分 类 号：R563.1[医药卫生—呼吸系统]