血清HMGB1和sRAGE对脓毒症相关性脑病患者发病及短期预后的预测价值

doi:10.11958/20242152

天津医药 ›› 2025, Vol. 53 ›› Issue (3): 262-266.doi: 10.11958/20242152

血清HMGB1和sRAGE对脓毒症相关性脑病患者发病及短期预后的预测价值

张宇轩¹(), 刘一丹², 陈哲³, 张雯³, 李瑞轩³, 闫强³, 徐桂萍³^,^△()

1 新疆医科大学研究生学院（邮编830000）
2 新疆医科大学附属肿瘤医院麻醉科
3 新疆维吾尔自治区人民医院麻醉科，新疆麻醉管理临床医学研究中心

收稿日期:2024-12-07 修回日期:2025-01-18 出版日期:2025-03-15 发布日期:2025-03-31
通讯作者: △E-mail：xuguipingmzk@163.com
作者简介:张宇轩（1989），男，主治医师，主要从事危重症患者麻醉方面研究。E-mail：boom_4512032@163.com
基金资助:
新疆维吾尔自治区研究生创新项目(XJ2023G203)

The predictive value of serum HMGB1 and sRAGE in the occurrence and short-term prognosis of sepsis-associated encephalopathy

ZHANG Yuxuan¹(), LIU Yidan², CHEN Zhe³, ZHANG Wen³, LI Ruixuan³, YAN Qiang³, XU Guiping³^,^△()

1 Graduate School of Xinjiang Medical University, Urumqi 830000, China
2 Department of Anesthesiology, Affiliated Cancer Hospital of Xinjiang Medical University
3 Department of Anesthesiology, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Clinical Research Center for Anesthesia Managemen

Received:2024-12-07 Revised:2025-01-18 Published:2025-03-15 Online:2025-03-31
Contact: △E-mail：xuguipingmzk@163.com

张宇轩, 刘一丹, 陈哲, 张雯, 李瑞轩, 闫强, 徐桂萍. 血清HMGB1和sRAGE对脓毒症相关性脑病患者发病及短期预后的预测价值[J]. 天津医药, 2025, 53(3): 262-266.

ZHANG Yuxuan, LIU Yidan, CHEN Zhe, ZHANG Wen, LI Ruixuan, YAN Qiang, XU Guiping. The predictive value of serum HMGB1 and sRAGE in the occurrence and short-term prognosis of sepsis-associated encephalopathy[J]. Tianjin Medical Journal, 2025, 53(3): 262-266.

摘要/Abstract

摘要：

目的探讨血清高迁移率族蛋白B1（HMGB1）、可溶性晚期糖基化终末产物受体（sRAGE）对脓毒症相关性脑病（SAE）发生和短期预后的预测价值。方法回顾性分析228例脓毒症患者的临床资料，根据是否发生SAE分为SAE组（96例）和非SAE组（132例）。比较2组患者临床资料、实验室检查结果、急性生理与慢性健康评分（APACHEⅡ）、序贯器官衰竭评分（SOFA）、血清HMGB1和sRAGE的差异。多因素Logistic回归分析SAE发生的影响因素。绘制受试者工作特征（ROC）曲线评估HMGB1、sRAGE和HMGB1/sRAGE对SAE发生及短期预后的预测能力。Kaplan-Meier法绘制生存曲线，比较HMGB1、sRAGE不同表达水平的SAE患者28 d死亡率的差异。结果与非SAE组相比，SAE组血清HMGB1升高，sRAGE降低，HMGB1/sRAGE比值升高（P<0.05）。血清HMGB1、sRAGE及HMGB1/sRAGE比值预测SAE发生的曲线下面积（AUC）分别为0.826（95%CI：0.770~0.872）、0.682（95%CI：0.617~0.742）和0.895（95%CI：0.848~0.932），均有一定预测价值。96例SAE患者入院28 d共计死亡52例（54.2%），死亡和存活患者间HMGB1、sRAGE及HMGB1/sRAGE差异均无统计学意义（P>0.05）。不同HMGB1、sRAGE表达水平的SAE患者28 d死亡率差异均无统计学意义。结论血清HMGB1升高、sRAGE降低对SAE的辅助诊断具有一定临床意义，但在短期预后评估中的应用价值有限。

Abstract:

Objective To explore the predictive value of serum high-mobility group box protein B1 (HMGB1) and soluble receptor for advanced glycation end-products (sRAGE) in the occurrence and short-term prognosis of sepsis-associated encephalopathy (SAE). Methods Clinical data of 228 patients with sepsis were retrospectively analyzed. According to the presence of SAE, patients were divided into the SAE group (96 cases) and the non-SAE group (132 cases). General clinical data, laboratory test results, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) scores, Sequential Organ Failure Assessment (SOFA) scores and serum HMGB1 and sRAGE levels were compared between the two groups. Multivariate Logistic regression analysis was performed to determine factors influencing SAE occurrence. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive ability of HMGB1, sRAGE and the HMGB1/sRAGE ratio to predict the occurrence and short-term prognosis of SAE. Kaplan-Meier survival curves were used to compare the 28-day mortality rates of SAE patients with different HMGB1 and sRAGE expression levels. Results Compared to the non-SAE group, patients in the SAE group exhibited elevated serum HMGB1 levels, decreased sRAGE levels and an increased HMGB1/sRAGE ratio (P<0.05). The areas under the curve (AUC) for predicting SAE using HMGB1, sRAGE and the HMGB1/sRAGE ratio were 0.826 (95% CI: 0.770-0.872), 0.682 (95% CI: 0.617-0.742) and 0.895 (95% CI: 0.848-0.932), respectively, indicating predictive value. Among the 96 SAE patients, 52 (54.2%) died within 28 days. There were no statistically significant differences in HMGB1, sRAGE and the HMGB1/sRAGE ratio between surviving and deceased patients (P>0.05). Similarly, there were no significant differences in 28-day mortality rates between SAE patients with different HMGB1 or sRAGE expression levels. Conclusion Elevated serum HMGB1 and reduced sRAGE are of significant value in the auxiliary diagnosis of SAE, but have limited clinical predictive value for short-term prognosis.

Key words: sepsis-associated encephalopathy, HMGB1 protein, receptor for advanced glycation end products, prognosis

中图分类号:

R631.3，R742

图/表 6

参考文献 20

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组别	n		年龄/ 岁	BMI/ （kg/m²）		男性	糖尿病		高血压		APACHEⅡ 评分/分		SOFA 评分/分	CRP/ （mg/L）		PCT/ （μg/L）		TNF-α/ （ng/L）		IL-6/ （ng/L）
非SAE组	132		60.8±9.9	23.7±3.1		79（59.8）	25（18.9）		49（37.1）		18.2±3.8		6.1±2.0	65.3±18.2		1.2±0.5		22.5±6.3		35.8±9.4
SAE组	96		63.7±11.1	24.3±3.4		57（59.4）	22（22.9）		41（42.7）		21.5±5.2		8.9±3.2	89.7±22.6		3.4±1.1		35.4±8.7		62.3±15.6
t或χ2			2.075^＊	1.462		0.005	0.517		0.574		5.538^＊＊		8.111^＊＊	9.021^＊＊		20.288^＊＊		12.989^＊＊		15.945^＊＊
组别		脑脊液葡萄糖/（mmol/L）			脑脊液蛋白/（g/L）			HMGB1/ （μg/L）		sRAGE/ （ng/L）		HMGB1/ sRAGE			乳酸/ （mmol/L）		白蛋白/ （g/L）		肌酐/ （μmol/L）
非SAE组		3.4±0.8			0.45±0.12			40.9±9.8		1 204.1±290.3		0.034±0.011			2.1±0.8		35.2±3.1		112.3±23.5
SAE组		2.9±0.6			0.69±0.18			58.8±15.1		988.3±242.2		0.059±0.014			2.9±1.2		32.4±2.9		145.7±31.2
t		5.158^＊＊			12.072^＊＊			10.841^＊＊		5.934^＊＊		14.522^＊＊			6.036^＊＊		6.918^＊＊		9.220^＊＊

组别	n		年龄/ 岁	BMI/ （kg/m²）		男性	糖尿病		高血压		APACHEⅡ 评分/分		SOFA 评分/分	CRP/ （mg/L）		PCT/ （μg/L）		TNF-α/ （ng/L）		IL-6/ （ng/L）
非SAE组	132		60.8±9.9	23.7±3.1		79（59.8）	25（18.9）		49（37.1）		18.2±3.8		6.1±2.0	65.3±18.2		1.2±0.5		22.5±6.3		35.8±9.4
SAE组	96		63.7±11.1	24.3±3.4		57（59.4）	22（22.9）		41（42.7）		21.5±5.2		8.9±3.2	89.7±22.6		3.4±1.1		35.4±8.7		62.3±15.6
t或χ2			2.075^＊	1.462		0.005	0.517		0.574		5.538^＊＊		8.111^＊＊	9.021^＊＊		20.288^＊＊		12.989^＊＊		15.945^＊＊
组别		脑脊液葡萄糖/（mmol/L）			脑脊液蛋白/（g/L）			HMGB1/ （μg/L）		sRAGE/ （ng/L）		HMGB1/ sRAGE			乳酸/ （mmol/L）		白蛋白/ （g/L）		肌酐/ （μmol/L）
非SAE组		3.4±0.8			0.45±0.12			40.9±9.8		1 204.1±290.3		0.034±0.011			2.1±0.8		35.2±3.1		112.3±23.5
SAE组		2.9±0.6			0.69±0.18			58.8±15.1		988.3±242.2		0.059±0.014			2.9±1.2		32.4±2.9		145.7±31.2
t		5.158^＊＊			12.072^＊＊			10.841^＊＊		5.934^＊＊		14.522^＊＊			6.036^＊＊		6.918^＊＊		9.220^＊＊

变量	B	SE	Wald χ2	P	OR	OR 95% CI
APACHEⅡ评分	0.243	0.063	14.986	<0.001	1.275	1.127~1.441
SOFA评分	0.336	0.086	15.289	<0.001	1.400	1.187~1.650
PCT	1.785	0.312	32.684	<0.001	5.960	3.226~11.009
HMGB1/sRAGE	1.895	0.717	13.435	<0.001	6.653	2.415~18.326
白蛋白	-0.297	0.073	16.462	<0.001	0.743	0.654~0.844
肌酐	0.027	0.006	22.334	<0.001	1.027	1.016~1.039
常数项	0.258	0.196	1.733	0.188	1.294

变量	B	SE	Wald χ2	P	OR	OR 95% CI
APACHEⅡ评分	0.243	0.063	14.986	<0.001	1.275	1.127~1.441
SOFA评分	0.336	0.086	15.289	<0.001	1.400	1.187~1.650
PCT	1.785	0.312	32.684	<0.001	5.960	3.226~11.009
HMGB1/sRAGE	1.895	0.717	13.435	<0.001	6.653	2.415~18.326
白蛋白	-0.297	0.073	16.462	<0.001	0.743	0.654~0.844
肌酐	0.027	0.006	22.334	<0.001	1.027	1.016~1.039
常数项	0.258	0.196	1.733	0.188	1.294

组别	n	HMGB1/（μg/L）	sRAGE/（ng/L）	HMGB1/sRAGE
存活组	44	57.1±16.6	1 001.8±199.3	0.057±0.014
死亡组	52	60.3±13.7	976.9±274.8	0.062±0.013
t		1.034	0.500	1.813

血清HMGB1和sRAGE对脓毒症相关性脑病患者发病及短期预后的预测价值

The predictive value of serum HMGB1 and sRAGE in the occurrence and short-term prognosis of sepsis-associated encephalopathy

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