本文選題：高遷移率族蛋白質(zhì)類　切入點：膿毒癥　出處：《中國全科醫(yī)學(xué)》2016年08期

【摘要】：目的探討高遷移率族蛋白1(HMGB1)對膿毒癥及相關(guān)急性腎損傷(AKI)的診斷和預(yù)后的評估價值。方法選取2014年10月—2015年3月武漢大學(xué)人民醫(yī)院確診的膿毒癥患者40例,根據(jù)病情嚴(yán)重程度分為普通膿毒癥組12例和嚴(yán)重膿毒癥組28例。將嚴(yán)重膿毒癥組患者根據(jù)28 d病情轉(zhuǎn)歸情況分為惡化亞組13例和好轉(zhuǎn)亞組15例;又根據(jù)是否并發(fā)AKI分為嚴(yán)重膿毒癥AKI亞組18例,嚴(yán)重膿毒癥非AKI亞組10例,同樣根據(jù)28 d病情轉(zhuǎn)歸情況將18例嚴(yán)重膿毒癥AKI患者進(jìn)一步分為惡化亞組11例和好轉(zhuǎn)亞組7例。另選取同期健康志愿者5例為對照組。收集患者入組24 h內(nèi)的臨床資料并采集血、尿標(biāo)本。酶聯(lián)免疫吸附法(ELISA)檢測血及尿HMGB1水平。采用SPSS 17.0軟件進(jìn)行統(tǒng)計學(xué)分析。結(jié)果 (1)40例膿毒癥患者的血及尿HMGB1水平均高于對照組(P0.01)。嚴(yán)重膿毒癥組血HMGB1水平高于普通膿毒癥組,差異有統(tǒng)計學(xué)意義(P=0.027)。當(dāng)以血HMGB1水平為1 225.1 ng/L作為鑒別嚴(yán)重膿毒癥與普通膿毒癥截斷點時,靈敏度與特異度分別為67.9%和75.0%,ROC曲線下面積為0.74〔95%CI(0.56,0.91),P=0.020〕。(2)Pearson相關(guān)分析結(jié)果顯示,血HMGB1水平與尿HMGB1水平、白細(xì)胞計數(shù)(WBC)及降鈣素原(PCT)呈正相關(guān)(r=0.472、0.597、0.473,P=0.011、0.001、0.011),尿HMGB1水平與估算腎小球濾過率呈正相關(guān)(r=0.480,P=0.010),與急性生理與慢性健康狀況評分系統(tǒng)Ⅱ(APACHEⅡ)評分、血肌酐水平呈負(fù)相關(guān)(r值分別為-0.506和-0.397,P值分別為0.006和0.038)。多元線性回歸分析結(jié)果顯示,尿HMGB1水平、WBC、PCT是嚴(yán)重膿毒癥組血HMGB1水平的影響因素,清蛋白與APACHEⅡ評分是尿HMGB1水平的影響因素(P0.05)。(3)當(dāng)以尿HMGB1水平為961.0 ng/L作為截斷點時,鑒別嚴(yán)重膿毒癥惡化與好轉(zhuǎn)的靈敏度與特異度分別為73.3%和92.3%,ROC曲線下面積為0.84〔95%CI(0.69,0.99),P=0.002〕。(4)當(dāng)以尿HMGB1水平為1 025.5 ng/L作為截斷點時,診斷膿毒癥AKI的靈敏度、特異度分別為70.0%和83.3%,ROC曲線下面積為0.73〔95%CI(0.53,0.93),P=0.046〕。(5)當(dāng)以尿HMGB1水平為875.6 ng/L作為截斷點時,預(yù)測膿毒癥AKI預(yù)后的靈敏度、特異度分別為71.4%和90.9%,ROC曲線下面積為0.90〔95%CI(0,0.99),P=0.006〕。(6)采用二元Logistic回歸分析膿毒癥AKI患者疾病轉(zhuǎn)歸與血、尿HMGB1水平及臨床指標(biāo)的相關(guān)性,結(jié)果顯示尿HMGB1水平及APACHEⅡ評分是膿毒癥患者AKI病情惡化的相關(guān)因素(b分別為0.010和-0.353,P值分別為0.037和0.046)。結(jié)論血、尿HMGB1在膿毒癥及相關(guān)AKI患者中均明顯升高,血HMGB1對膿毒癥病情嚴(yán)重程度有鑒別價值,尿HMGB1有助于診斷膿毒癥AKI并評估嚴(yán)重膿毒癥及膿毒癥AKI患者的預(yù)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，

本文編號：1673522