The Clinical Study Of The Role Of High Mobility Group Box 1 On Both Diagnosis And Disease Evaluation In The Patients With Acute Kidney Injury

Objective:To analyze the association between serum high mobility group box 1(HMGB1)and other clinical indexes,such as urinary N-acetyl-?-DGlucosaminidase(NAG),serum creatinine(Scr),urea nitrogen(BUN),white blood cells(WBC),C reactive protein(CRP),erythrocyte sedimentation rate(ESR),etc.As well as the association between HMGB1 and the acute physiology and chronic health evaluation(APACHE?).To explore the pathogenesis of late inflammation and the prognosis in AKI,and whether HMGB1 can be used as a biological marker for the diagnosis in AKI.Methods:1.Select 60 patients with AKI as the patient group who were admitted to Department of Nephrology and ICU from DEC,2015 to DEC,2016.Collect the blood and urine samples to measure HMGB1 and other clinical indexes in 60 patients with AKI and 30 age-matched healthy controls.Based on 28-day mortality,we divided the patients with AKI into survivors group and non-survivors group.2.Serum HMGB1 levels were measured by ELISA.3.Statistical analysis: Data are presented as the mean ± SD for continuous variables.Univariate comparisons of continuous variablesbetween control subjects and AKI patients were conducted with unpaired sample t-tests;Association among analyzed parameters(HMGB1 with other clinical indexes and APACHE ? score)was assessed using Spearman's correlation coefficient.Logistic regression analysis was used to assess the risk factors of death in patients with AKI.Statistical analysis were performed using SPSS 17.0 software.All results were considered statistically significant at P<0.05.Results:1.General data: the AKI patients group were 60 cases,were divided into ischemic etiology in 26 cases(43.3%),renal toxicity in 13 cases(21.7%),others factors(sepsis and post-renal)in 21 cases(35%).22 nonsurvivors group,38 survivors group,and 30 controls group,have no significant difference in gender and age form(P>0.05).The AKI patients group and the controls group have significant difference in the urinary NAG,(serum creatinine,urea nitrogen,etc(P<0.5).The mortality rate of AKI was 36.7%.The survivors group and the nonsurvivors group have significant difference in the urinary NAG,APACHE ? score and a number of indexes(P < 0.5).2.Serum HMGB1 detection: serum HMGB1 was increased in AKI(8.02±3.97)ng/ml versus controls group(1.10±0.54)ng/ml,as well as nonsurvivors group(11.82±3.44 ng/ml)versus survivors group(5.83±2.21)ng/ml,both P< 0.01.3.Serum HMGB1 levels were associated with urinary NAG,APACHE? score,serum creatinine,urea nitrogen,white blood cells,C reactive protein,?1-microglobulin,and negatively with albumin,prealbumin,platelet.4.The Logistic regression analysis showed that the risk factors ofdeath in patients with AKI included :serum HMGB1,urinary NAG,and APACHE II score.Conclusion :The study showed that: 1.HMGB1 may play an important role of pathogenesis and development in AKI as a late mediator of inflammation.2.The association between HMGB1 and APACHE II score,showed that HMGB1 may have certain ability to predict mortality in patients with AKI,and the combination of these two assessment may be more clinical significance to predict the prognosis of patients with AKI.3.HMGB1 may exacerbate the kidney injury through influence the function of renal tubules.