高迁移率族蛋白1对脓毒症及相关急性肾损伤的诊断和预后评估价值研究

发布时间：2018-03-27 22:21

  本文选题：高迁移率族蛋白质类　切入点：脓毒症　出处：《中国全科医学》2016年08期

【摘要】：目的探讨高迁移率族蛋白1(HMGB1)对脓毒症及相关急性肾损伤(AKI)的诊断和预后的评估价值。方法选取2014年10月—2015年3月武汉大学人民医院确诊的脓毒症患者40例,根据病情严重程度分为普通脓毒症组12例和严重脓毒症组28例。将严重脓毒症组患者根据28 d病情转归情况分为恶化亚组13例和好转亚组15例;又根据是否并发AKI分为严重脓毒症AKI亚组18例,严重脓毒症非AKI亚组10例,同样根据28 d病情转归情况将18例严重脓毒症AKI患者进一步分为恶化亚组11例和好转亚组7例。另选取同期健康志愿者5例为对照组。收集患者入组24 h内的临床资料并采集血、尿标本。酶联免疫吸附法(ELISA)检测血及尿HMGB1水平。采用SPSS 17.0软件进行统计学分析。结果 (1)40例脓毒症患者的血及尿HMGB1水平均高于对照组(P0.01)。严重脓毒症组血HMGB1水平高于普通脓毒症组,差异有统计学意义(P=0.027)。当以血HMGB1水平为1 225.1 ng/L作为鉴别严重脓毒症与普通脓毒症截断点时,灵敏度与特异度分别为67.9%和75.0%,ROC曲线下面积为0.74〔95%CI(0.56,0.91),P=0.020〕。(2)Pearson相关分析结果显示,血HMGB1水平与尿HMGB1水平、白细胞计数(WBC)及降钙素原(PCT)呈正相关(r=0.472、0.597、0.473,P=0.011、0.001、0.011),尿HMGB1水平与估算肾小球滤过率呈正相关(r=0.480,P=0.010),与急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、血肌酐水平呈负相关(r值分别为-0.506和-0.397,P值分别为0.006和0.038)。多元线性回归分析结果显示,尿HMGB1水平、WBC、PCT是严重脓毒症组血HMGB1水平的影响因素,清蛋白与APACHEⅡ评分是尿HMGB1水平的影响因素(P0.05)。(3)当以尿HMGB1水平为961.0 ng/L作为截断点时,鉴别严重脓毒症恶化与好转的灵敏度与特异度分别为73.3%和92.3%,ROC曲线下面积为0.84〔95%CI(0.69,0.99),P=0.002〕。(4)当以尿HMGB1水平为1 025.5 ng/L作为截断点时,诊断脓毒症AKI的灵敏度、特异度分别为70.0%和83.3%,ROC曲线下面积为0.73〔95%CI(0.53,0.93),P=0.046〕。(5)当以尿HMGB1水平为875.6 ng/L作为截断点时,预测脓毒症AKI预后的灵敏度、特异度分别为71.4%和90.9%,ROC曲线下面积为0.90〔95%CI(0,0.99),P=0.006〕。(6)采用二元Logistic回归分析脓毒症AKI患者疾病转归与血、尿HMGB1水平及临床指标的相关性,结果显示尿HMGB1水平及APACHEⅡ评分是脓毒症患者AKI病情恶化的相关因素(b分别为0.010和-0.353,P值分别为0.037和0.046)。结论血、尿HMGB1在脓毒症及相关AKI患者中均明显升高,血HMGB1对脓毒症病情严重程度有鉴别价值,尿HMGB1有助于诊断脓毒症AKI并评估严重脓毒症及脓毒症AKI患者的预后。
[Abstract]:Objective to evaluate the value of high mobility group protein (HMGB1) in the diagnosis and prognosis of sepsis and associated acute renal injury (AKI). Methods Forty patients with sepsis diagnosed in the people's Hospital of Wuhan University from October 2014 to March 2015 were selected. According to the severity of the disease, the patients were divided into common sepsis group (n = 12) and severe sepsis group (n = 28). The patients in severe sepsis group were divided into worsening subgroup (n = 13) and improvement subgroup (n = 15). According to whether the patients were complicated with AKI, they were divided into severe sepsis AKI subgroup (18 cases) and severe sepsis non AKI subgroup (10 cases). According to the outcome of 28 days, 18 patients with severe sepsis AKI were further divided into deterioration subgroup (n = 11) and improvement subgroup (n = 7). Five healthy volunteers were selected as control group. Bed data and blood collection, Urine samples. Enzyme linked immunosorbent assay (Elisa) was used to detect HMGB1 levels in blood and urine. SPSS 17.0 software was used for statistical analysis. Results the serum and urine HMGB1 levels in 40 patients with sepsis were higher than those in control group (P 0.01). The serum HMGB1 level in severe sepsis patients was high. In the common sepsis group, When the blood HMGB1 level was 1 225.1 ng/L as the cut-off point for distinguishing severe sepsis from common sepsis, the sensitivity and specificity were 67.9% and 75.0%, respectively. There was a positive correlation between serum HMGB1 level and urinary HMGB1, leukocyte count and procalcitonin (PTC). There was a positive correlation between urinary HMGB1 level and glomerular filtration rate, and with acute physiological and chronic health scoring system 鈪，

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