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目的 测定重型颅脑损伤患者血清高迁移率族蛋白B1 (HMGB1)、肿瘤坏死因子-α(TNF-α)、白细胞介素石(IL-6)、C反应蛋白(CRP)浓度,分析HMGB1与TNF-α、IL-6、CRP的相关性.分析HMGB1质量浓度与预后的相关性.方法 回顾性研究2011年3月至2012年3月泰州市人民医院75名经临床及头颅CT均证实为重型颅脑损伤患者,GCS评分5～8分持续12h以上,并除外高血压、糖尿病和严重心、肝、肾疾病病史及其他部位外伤患者.对照组为同期健康体检正常者50例,对照组静脉血为体检时获得,外伤组静脉血在入院当天获得.ELISA测定血清HMGB1、TNF-α、IL-6质量浓度,全自动生化分析仪检测CRP质量浓度.统计学采用SPSS 13.0软件,成组t检验比较外伤组与对照组血清HMGB1、TNF-α、IL-6、CRP的质量浓度,采用相关性分析HMGB1与TNF-α、IL-6、CRP的关系.外伤组患者根据其最终预后分为存活组和死亡组,分别测定第1天、第3天、第7天两组患者血清HMGB1质量浓度,t检验比较死亡组与存活组的HMGB1的质量浓度.结果 外伤组患者血清HMGB1质量浓度显著高于对照组(P＜0.01).外伤组患者血清HMGB1质量浓度与TNF-α、IL-6、CRP水平呈正相关(r=0.365,P＜0.05;r =0.530,P＜0.05;r =0.661,P＜0.05).外伤组患者中死亡组的HMGB1质量浓度在l周内持续性升高,且明显高于存活组(P＜0.01).结论 重型颅脑外伤后血清HMGB1质量浓度显著升高,HMGB1质量浓度与炎症因子TNF-α、IL-6、CRP的质量浓度呈正相关,临床检测HMGB1质量浓度有助于早期判断重型脑外伤的预后.

Objective To detect the levels of high mobility group box 1 protein HMGB1),tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6),C-reactive protein (CRP) in order to explore the clinical significance of HMGB1 in patients with severely traumatic brain injury.Methods A total of 75 patients composed of 40 male and 35 female with severely traumatic brain injury were hospitalized from March 2011 through March 2012.The scores of Glasgow Coma Scale (GCS) were 5-8 within 12 hours after brain injury.Casualties with history of hypertension,diabetes,severe diseases of heart,liver and kidney,and with concurrent trauma of other parts of body were excluded.Another 50 healthy subjects were enrolled as controls.Serum samples were taken from both patients and controls at admission.The levels of HMGB1,TNF-α and IL-6 were measured by using enzyme-linked immunosorbent assay (ELISA).The level of CRP was measured by using automatic biochemistry analyzer.Comparisons of the levels of HMGB1,TNF-α,IL-6and CRP between casuahies and healthy controls were carried out.The correlations of HMGB1 with TNF-α,IL-6,CRP in patients with severe traumatic brain injury were analyzed.Thereafter,75 patients were divided into two groups post hoc:the death group and the survival group.On the 1st day,the 3rd day and the 7th day after trauma,serum HMGB1 was detected.The comparison of HMGB1 was made between death group and survival group by using t-test.Results Serum HMGB1 level in the traumatic patients was higher than that of healthy controls (P ＜ 0.01).Correlative analysis showed that there was a positive correlation between HMGB1 and TNF-α (r =0.365,P＜0.05),IL-6 (r=0.530,P＜0.05),CRP (r=0.661,P＜0.05) in patients with severe traumatic brain injury.Serum HMGB1 level in the death group was higher than the survival group (P ＜ 0.01).Conclusions Increased serum HMGB1 level was found after severe traumatic brain injury.There were positive correlations between HMGB1 and three inflammatory factors,TNF-α,IL-6and CRP.Serum HMGB1 should be used as reliable hiomarker to judge the prognosis of patients with severe traumatic brain injury.