van Zoelen Marieke A D, Ishizaka Akitoshi, Wolthuls Esther K, Choi Goda, van der Poll Tom, Schultz Marcus J
Center for Infection and Immunity Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.
Shock. 2008 Apr;29(4):441-5. doi: 10.1097/SHK.0b013e318157eddd.
High-mobility group box (HMGB) 1 is a recently discovered proinflammatory mediator that contributes to acute lung injury. We determined HMGB-1 levels in bronchoalveolar lavage fluid of patients during mechanical ventilation (MV) and ventilator-associated pneumonia (VAP). Bronchoalveolar lavage fluid was obtained from patients who were ventilated for 5 h because of an elective surgical procedure ("short-term MV"; n = 40) or for several days because of respiratory failure without acute lung injury ("long-term MV"; n = 10) and from patients who developed unilateral VAP (n = 4). Ten healthy volunteers served as controls. In healthy volunteers, HMGB-1 levels were low (median, 1.6 ngmL(-1); interquartile range [IQR], 0.7-3.7 ng mL(-1)). Although HMGB-1 levels were elevated after short-term MV, differences were not statistically significant compared with healthy volunteers (1.7 ng mL(-1); IQR, 0.8-8.5 ng mL(-1), P = 0.493 vs. healthy volunteers; P = 0.250 vs. start of MV). However, HMGB-1 levels were significantly higher in "long-term" MV patients (11.7 ng mL(-1); IQR, 8.7-37.0 ng mL(-1); P < 0.0001 vs. healthy volunteers). With unilateral VAP, HMGB-1 levels from the infected lung.were 17.4 (IQR, 8.5-23.2) ng mL(-1) (P = 0.014 vs. healthy controls); these levels were not different from those measured in the contralateral noninfected lung (P = 0.625). Summarized, long-term MV is associated with increased HMGB-1 levels in contrast to "short-term" MV. In addition, HMGB-1 levels during VAP are increased compared with healthy volunteers; however, they are not different from those found in patients intubated and mechanically ventilated for a similar period of time.
高迁移率族蛋白盒1（HMGB）1是最近发现的一种促炎介质，可导致急性肺损伤。我们测定了机械通气（MV）和呼吸机相关性肺炎（VAP）患者支气管肺泡灌洗液中的HMGB-1水平。支气管肺泡灌洗液取自因择期手术而通气5小时的患者（“短期MV”；n = 40）或因呼吸衰竭且无急性肺损伤而通气数天的患者（“长期MV”；n = 10）以及发生单侧VAP的患者（n = 4）。10名健康志愿者作为对照。健康志愿者的HMGB-1水平较低（中位数为1.6 ng/mL；四分位间距[IQR]为0.7 - 3.7 ng/mL）。尽管短期MV后HMGB-1水平升高，但与健康志愿者相比差异无统计学意义（1.7 ng/mL；IQR为0.8 - 8.5 ng/mL，与健康志愿者相比P = 0.493；与MV开始时相比P = 0.250）。然而，“长期”MV患者的HMGB-1水平显著更高（11.7 ng/mL；IQR为8.7 - 37.0 ng/mL；与健康志愿者相比P < 0.0001）。对于单侧VAP，感染肺的HMGB-1水平为17.4（IQR为8.5 - 23.2）ng/mL（与健康对照相比P = 0.014）；这些水平与对侧未感染肺中测得的水平无差异（P = 0.625）。总之，与“短期”MV相比，长期MV与HMGB-1水平升高相关。此外，VAP期间的HMGB-1水平与健康志愿者相比有所升高；然而，它们与在类似时间段内插管并机械通气的患者中发现的水平无差异。
