CAJ | 학술논문

目的：探讨严重创伤患者高迁移率族蛋白B1（HMGB1)浓度变化及创伤严重程度（ISS)评分与预后的相关性。方法选择2009年1月—2013年1月我院收治的严重创伤80例，根据预后情况分为存活组（48例)及死亡组（32例)两组。两组均于入院第1、3、5、7、9天检测HMGB1和HMGB1 mRNA浓度、进行ISS评分并比较，于HMGB1浓度发生转折时检测比较脏器损伤相关血生化指标。利用受试者工作特征（ ROC)曲线分析HMGB1在严重创伤患者预后评估中的价值，采用Spearman相关分析分析HMGB1水平与ISS评分的相关性。结果入院第1天两组HMGB1、HMGB1 mRNA浓度及ISS评分比较差异无统计学意义（ P>0．05)，入院第3、5、7、9天死亡组HMGB1、HMGB1 mRNA浓度及ISS评分均高于存活组，差异有统计学意义（P<0．05或P<0．01)。存活组入院第7天时HMGB1浓度开始下降，此时死亡组血清丙氨酸转氨酶（ ALT)、天冬氨酸转氨酶（ AST)、尿素（ BUN)、肌酐（ Cr)、肌酸激酶（ CK)、心肌型肌酸激酶同工酶（ CK-MB)浓度均明显高于存活组，氧分压（ PaO2)明显低于存活组，差异皆有统计学意义（ P<0．05)。ROC曲线分析结果显示HMGB1评估严重创伤患者预后具有较高的敏感度及特异度。 Spearman相关分析结果显示HMGB1水平与ISS评分呈正相关。结论动态监测严重创伤患者HMGB1浓度对预测预后有一定临床意义；HMGB1水平与ISS评分呈正相关。
목적：탐토엄중창상환자고천이솔족단백B1（HMGB1)농도변화급창상엄중정도（ISS)평분여예후적상관성。방법선택2009년1월—2013년1월아원수치적엄중창상80례，근거예후정황분위존활조（48례)급사망조（32례)량조。량조균우입원제1、3、5、7、9천검측HMGB1화HMGB1 mRNA농도、진행ISS평분병비교，우HMGB1농도발생전절시검측비교장기손상상관혈생화지표。이용수시자공작특정（ ROC)곡선분석HMGB1재엄중창상환자예후평고중적개치，채용Spearman상관분석분석HMGB1수평여ISS평분적상관성。결과입원제1천량조HMGB1、HMGB1 mRNA농도급ISS평분비교차이무통계학의의（ P>0．05)，입원제3、5、7、9천사망조HMGB1、HMGB1 mRNA농도급ISS평분균고우존활조，차이유통계학의의（P<0．05혹P<0．01)。존활조입원제7천시HMGB1농도개시하강，차시사망조혈청병안산전안매（ ALT)、천동안산전안매（ AST)、뇨소（ BUN)、기항（ Cr)、기산격매（ CK)、심기형기산격매동공매（ CK-MB)농도균명현고우존활조，양분압（ PaO2)명현저우존활조，차이개유통계학의의（ P<0．05)。ROC곡선분석결과현시HMGB1평고엄중창상환자예후구유교고적민감도급특이도。 Spearman상관분석결과현시HMGB1수평여ISS평분정정상관。결론동태감측엄중창상환자HMGB1농도대예측예후유일정림상의의；HMGB1수평여ISS평분정정상관。
Objective To discuss the correlation between the HMGB1 concentration changes and injury severity scores of patients with severe trauma and the prognosis. Methods 80 cases of patients with severe trauma admitted to our hospital during January 2009 and January 2013 according to the prognosis were divided into survival group ( n=48 cases) and mortality group ( n=32 cases) . Peripheral blood concentration of HMGB1 and HMGB1 mRNA and ISS scores evaluation in the two groups of patients were detected on 1st d, 3rd d, 5th d, 7th d, 9th d after admission, and viscera damage related bio-chemical indicators was detected when the concentration of HMGB1 changed. The receiver-operating characteristic ( ROC) curve was used to analyze the prognosis value in evaluation of HMGB1 in the patients with severe trauma, spearman correlation analysis was used to analyze the correlation of HMGB1 level and the ISS score. Results The concentration of HMGB1, mRNA HMGB1 and ISS scores in the two groups on 1 st d upon admission showed no statistically significant differences between the two groups (P>0. 05). On the 3rd d, 5th d, 7th d, 9th d upon admission, the concentrations of HMGB1 and HMGB1 mR-NA and ISS scores of the mortality group were higher than that of survival group, and the differences were of statistical signifi-cance (P<0. 05 or P<0. 01). HMGB1 concentration of the survival group began to decrease on 7th d, the concentrations of serum alanine aminotransferase ( ALT) , aspartate transaminase ( AST) , blood urea nitrogen ( BUN) , creatinine ( Cr) , serum creatine kinase ( CK) , creatine kinase isoenzyme ( CK-MB) in the mortality group were obviously higher than that of the sur-vival group (P<0. 05), but PaO2 was significantly lower than that of the survival group (P<0. 05). ROC curve showed that HMGB1 had ideal sensitivity and specificity in assessing the prognosis of severe trauma and the Spearman correlation analysis showed that HMGB1 levels had positive correlation with the ISS scores. Conclusion The dynamic monitoring of HMGB1 has certain clinical significance in predicting the prognosis of patients with severe traumawhile and the HMGB1 levels has positive correlation with ISS scores.