肝移植术后外周血高迁移率蛋白B1的变化及其与早期脓毒症的关系
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陈规划 E-mail:chgh1955@263.net

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国家重点基础研究发展计划(973计划)课题(2009CB522404);国家十一五科技重大专项课题(2008ZX10002-026);广东省科技计划项目重大专项(2007A032000001);广东省医学科学基金(B20080850);广州市科技计划项目(2009Z1-211);国家自然科学基金(30972914)。


The relationship between high mobility group box-1 protein in peripheral blood and early sepsis after liver transplantation
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    摘要:

    目的:研究因肝衰竭行肝移植患者围术期外周血高迁移率蛋白1 (high mobility group box-1 protein, HMGB1)的动态变化,探讨其与早期脓毒症的关系。
    方法:前瞻性选取2008年10月—2009年7月因肝衰竭行肝移植手术患者17例作为研究对象,采用荧光定量RT-PCR方法检测手术开始前30 min,术后第1,3,7,14 d 5个时间点外周血HMGB1 mRNA。根据术后早期(14 d内)是否发生脓毒症分成脓毒症组和非脓毒症组,比较两组患者HMGB1 mRNA的动态变化和差异。
    结果:17例患者中男14例,女3例,年龄31~65岁,平均(45.3±9.0)岁。8例患者术后早期发生脓毒症,脓毒症诊断平均时间为5.5 d(4~10 d)。非脓毒症组术后第1天HMGB1 mRNA表达水平较术前显著升高[(3.50±1.20) vs.(1.80±0.59),P=0.036],第3天达到高峰(7.85±3.00,P<0.001),然后逐渐下降,第14天回复至术前水平(2.62±1.11,P=0.301)。 脓毒症组术后第1天HMGB1 mRNA表达水平较术前显著上升[(7.31±2.27) vs.(1.92±0.64),P=0.002],并一直维持在较高水平,第14天仍高于术前(12.45±5.58,P<0.001)。脓毒症组术后各时间点HMGB1 mRNA均高于非脓毒症组(P<0.001)。
    结论:动态监测HMGB1的表达水平有助于预测肝移植术后早期脓毒症的发生。

    Abstract:

    Objective:To investigate the expression of high mobility group box-1 protein, (HMGB1) mRNA in the peripheral blood after liver transplantation and the relationship between HMGB1 and early sepsis after transplantation.
    Methods:The clinical and laberatory data of 17 patients underwent liver transplantation for hepatic failure were prospectively enrolled into this study. HMGB1 mRNA of peripheral blood was detected at 30 min before transplantation and on 1, 3, 7, 14 d after transplantation by reverse transcription-polymerase chain reaction (RT-PCR). Patients were divided into 2 groups according to whether development of early sepsis or not. HMGB1 mRNA expression was compared between the 2 groups.
    Results:The study included 14 males and 3 females, with mean age of (45.3±9.0) years (range, 31-65 years). Eight patients developed early sepsis. The mean time of diagnosis of sepsis was 5.5d(4-10 d). HMGB1 mRNA expression in non-sepsis group was significantly elevated on 1 d after transplantation compared to that of pre-transplantation[(3.50±1.20) vs.(1.80±0.59), P=0.036], and reached to the peak on 3 d after transplantation (7.85±3.00,P<0.001). Then it began to decrease and come down to the level of pre-transplantation(2.62±1.11,P=0.301). After transplantation, HMGB1 mRNA expression in sepsis group elevated significantly on 1d [(7.31±2.27) vs. (1.92±0.64),P=0.002], and maintained at high level on 14 d which was still significant higher than that of pre-transplantation(12.45±5.58, P<0.001). The expression of HMGB1 mRNA of sepsis group was significant higher than that of non-sepsis group after transplantation(P<0.001).
    Conclusions:Dynamic mornitoring expression of HMGB1 may help to predict the development of early sepsis.

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李敏如|易述红|赵辉|蔡常洁|曾芳芳|陈规划.肝移植术后外周血高迁移率蛋白B1的变化及其与早期脓毒症的关系[J].中国普通外科杂志,2010,19(7):730-734.
DOI:10.7659/j. issn.1005-6947.2010.07.003

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  • 收稿日期:2010-04-08
  • 最后修改日期:2010-06-12
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  • 在线发布日期: 2010-07-15