CAJ | 학술논문

目的：探讨高迁移率族蛋白1（HMGB-1）在肾综合征出血热（HFRS ）疾病早期预警及预后评估中的应用价值．方法：随机纳入105例2011-10/2012-12在我中心住院的HFRS患者．结合临床分型标准，将其分为轻型、中型、重型和危重型组．随机抽取上述患者急性期血浆标本93份，恢复期标本78份，28份健康志愿者血浆标本作对照，应用ELISA检测HMGB-1的表达．比较各型 HFRS 患者急性期与恢复期HMGB-1的表达变化，分析HMGB-1与预后的相关性，进一步应用ROC曲线分析HMGB-1预测预后的价值．结果：纳入的患者中，轻型19例，中型25例，重型27例，危重型34例．危重型患者中12例死亡，住院病死率为11．42％．各型患者在年龄及姓别分布差异无统计学意义．各型患者急性期及恢复期采血病日比较无统计学意义．急性期各型患者HMGB-1水平均高于健康对照（P＜0．001），且随着病情加重，急性期HMGB-1水平表达逐渐增高．恢复期除轻型患者外，HMGB-1水平均高于健康对照（P＜0．05），且危重型HMGB-1表达高于轻、中型（P＜0．05）．Spearman分析显示HMGB-1与HFRS预后有相关性（r＝0．275，P＜0．001），ROC 曲线分析显示HMGB-1在预后评估中有统计学意义（AUC ＝0．800，95％CI：0．645-0．955，P＜0．001）．结论：HMGB-1可作为HFRS疾病早期预警及预后评估中的一个重要生物标记物．
목적：탐토고천이솔족단백1（HMGB-1）재신종합정출혈열（HFRS ）질병조기예경급예후평고중적응용개치．방법：수궤납입105례2011-10/2012-12재아중심주원적HFRS환자．결합림상분형표준，장기분위경형、중형、중형화위중형조．수궤추취상술환자급성기혈장표본93빈，회복기표본78빈，28빈건강지원자혈장표본작대조，응용ELISA검측HMGB-1적표체．비교각형 HFRS 환자급성기여회복기HMGB-1적표체변화，분석HMGB-1여예후적상관성，진일보응용ROC곡선분석HMGB-1예측예후적개치．결과：납입적환자중，경형19례，중형25례，중형27례，위중형34례．위중형환자중12례사망，주원병사솔위11．42％．각형환자재년령급성별분포차이무통계학의의．각형환자급성기급회복기채혈병일비교무통계학의의．급성기각형환자HMGB-1수평균고우건강대조（P＜0．001），차수착병정가중，급성기HMGB-1수평표체축점증고．회복기제경형환자외，HMGB-1수평균고우건강대조（P＜0．05），차위중형HMGB-1표체고우경、중형（P＜0．05）．Spearman분석현시HMGB-1여HFRS예후유상관성（r＝0．275，P＜0．001），ROC 곡선분석현시HMGB-1재예후평고중유통계학의의（AUC ＝0．800，95％CI：0．645-0．955，P＜0．001）．결론：HMGB-1가작위HFRS질병조기예경급예후평고중적일개중요생물표기물．
AIM:To examine the predictive role of high mobility group box protein-1 (HMGB-1 )on severity and prognosis of hem-orrhagic fever with renal syndrome (HFRS).METHODS:One hundred and five patients treated at our center between October 201 1 and December 2012 were randomly enrolled in this study. The patients were divided into a mild-type group,a moderate-type group,a severe-type group and a critical-type group according to the HFRS criteria of clinical classification.Ninety three plasma samples of the patients during the acute stage and 78 samples dur-ing the convalescent stage were obtained, and 28 samples of healthy subjects were obtained as healthy controls.The concentra-tions of HMGB-1 were detected by enzyme linked immunosorbent assay (ELISA).The levels of HMGB-1 among the different types were compared respectively;the correlation between HMGB-1 and the survival was analyzed.The predictive effectiveness for progno-sis on HMGB-1 was evaluated using receiver operating characteris-tic (ROC)curve analysis.RESULTS:Of enrolled patients,19 cases were classified as mild,25 cases were classified as moder-ate,27 cases were classified as severe and 34 cases were classi-fied as critical.Twelve critical cases died with a hospital mortality of 1 1 .42%.There was no statistical difference on sex and age distribution among the corresponding groups.The time length from disease onset to plasma sample collection was not significantly dif-ferent.The levels of HMGB-1 in patient groups during the acute stage were significantly higher than that of the healthy control (P<0.001),and the levels of HMGB-1 are positively associated with the severity of the disease.The levels of HMGB-1 in patient groups were higher than that of the healthy control group during the convalescent stage except for the mild-type group (P <0.05),and the HMGB-1 levels of the critical-type group were higher compared with the mild- and moderate-type group (P <0.05).HMGB-1 was correlated with the prognosis as shown by Spearman correlation analysis (r=0.275,P<0.001).ROC a-nalysis revealed that HMGB-1 had statistical significance for pre-dicting prognosis with the area under the curve (AUC)of 0.800 (95% confidence interval:0.645 -0.955,P<0.001).CON-CLUSION:HMGB-1 can be considered as a new biomarker to e-valuate the severity and outcome in patients with HFRS.