论文部分内容阅读
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。
Objective To investigate the dynamic changes of peripheral blood high mobility group box-1 protein (HMGB1) in patients with liver failure undergoing liver transplantation in order to explore its relationship with early sepsis. Methods Seventeen patients undergoing liver transplantation undergoing liver failure from October 2008 to July 2009 were prospectively selected for the study. Fluorescent quantitative RT-PCR was used to detect the levels of serum lipids during the first 30 min, 14 d 5 time points of peripheral blood HMGB1 mRNA. According to whether the sepsis was divided into sepsis group and non-sepsis group in the early postoperative period (within 14 days), the dynamic changes and differences of HMGB1 mRNA in the two groups were compared. Results Among the 17 patients, 14 were males and 3 females, ranging in age from 31 to 65 years (mean, 45.3 ± 9.0) years. Sepsis occurred in 8 patients early after operation, and the average time for diagnosis of sepsis was 5.5 d (4 ~ 10 d). The expression of HMGB1 mRNA in non-sepsis group was significantly higher than that before the operation (3.50 ± 1.20 vs. 1.80 ± 0.59, P = 0.036), peaked on the third day (7.85 ± 3.00, P <0.001), then decreased gradually and returned to preoperative level on the 14th day (2.62 ± 1.11, P = 0.301). The level of HMGB1 mRNA in sepsis group was significantly higher than that before operation [(7.31 ± 2.27) vs. (1.92 ± 0.64), P = 0.002], and remained high at 14 days Preoperatively (12.45 ± 5.58, P <0.001). HMGB1 mRNA in sepsis group was significantly higher than that in non-sepsis group at each time point (P <0.001). Conclusion The dynamic monitoring of the expression of HMGB1 is helpful to predict the incidence of early sepsis after liver transplantation.