The Relationship Of HMGB1 Levels And Correlative Clinic Data In Sepsis

ObjectSepsis refers to a systemic inflammatory response syndrome resulting from infection. Inflammatory mediators is very important in occurrence of sepsis.But antibody of early inflammatory mediators can not improve the survival rate of patient. So to investigate the late mediator is very significant.HMGB1 are supported by extensive studies of sepsis as a late inflammatory mediators, stand a good chance to be a new effective target molecule. Here we discuss the relativity of HMGB1 and occurrence and prognosis of sepsis, investigate the relation between HMGB1 and other clinic data, APACHEII, TNF-a to afford theoretic basis as a potential therapeutic target.Methods1. Select 56 patients with sepsis as the patient group who were admitted to ICU between MAY,2009 and DEC,2009, including 30 severe sepsis patients and 26 common sepsis patients which possessed of complete clinic data. Collect the first day blood samples to measure HMGB1 and TNF-a in serum. Stat clinic data and pathogenic data. Based on 28-day mortality, we divided the patients into survival group and nonsurvival group.26 healthy controls are included in the study.2. HMGB1 and TNF-a levels measure by ELISA.3. Statistical analysis:AdoptingΧ2-test method in comparing the qualitative data and two independent samples t-test in two groups. More than two groups, using one-way ANOVA, using Spearman correlation to analysis the correlation between HMGB1 and other clinical indicators. Applying Logistic regression analysis to assess the risk factors of death in patients with severe sepsis. Evaluate the diagnostic accuracy of the HMGB1 and other data by ROC curves. SPSS 16.0 software used for statistical analysis, and a two-tailed P-value< 0.05 was considered significant.Results1. Commonly data:26 common sepsis,30 severe sepsis and 26 healthy controls have no significant difference in gender and age form.(P>0.05). In the first day of admitting,the N%, PLT, ALB, of the common and severe sepsis have difference compared with the control group(P<0.05).Patient group,17 nonsurvivors., the mortality is 30.35%.The number of organ failure,APACHEⅡscore are significantly higher than those survivals(P<0.01). Compared with survivor group,in first, third,7th day, PLT(P<0.05) of nonsurvivors descend and D-D (P<0.05)ascend,ALB have no difference(P>0.05).2 Pathogenic data and drug resistant of patient:Pseudomonas aeruginosa, Staphylococcus aureus, Candida albicans are the first three pathogens.3. HMGB1 detection:common sepsis(103.95±46.98) ng/ml, severe sepsis(115.85±103.26) ng/ml significantly increase then controls(44.78±16.16) ng/ml(P<0.05); level of nonsurvivors (83.67±25.61) ng/ml not significantly lower than survival (145.96±32.78) ng/ml. (P>0.05)4.TNF-αdetection:common sepsis(18.19±13.88) pg/ml, severe sepsis(34.42±10.60) pg/ml increase then controls(17.78±12.63) pg/ml,but not significant(P>0.05); level of nonsurvivors (42.96±16.48) pg/ml significantly higher than survival (29.81±6.54) pg/ml. (P＜0.01)5.There was positively correlated between HMGB1 and APACHEⅡ, there was negative correlated between HMGB1 and ALB.5. The results from Logistic regression analysis show that the factors significantly related with death in patients with severe sepsis include:APACHEⅡ, TNF-α.ConclusionHMGB1 level increased in sepsis.It can be a useful immunity mediator in happening and development of sepsis. The levels of nonsurvivors lower than survivors, so it can't be used to predict the prognosis in patient. Correspondingly, the level of TNF-αin nonsurvivors higher than survivors, and APACHEⅡscore square under the ROC curve is the biggest. So binding the APACHEⅡand TNF-αto predict the prognosis in patients with severe sepsis maybe have more clinic value.