Department of Clinical and Experimental Medicine and Pharmacology, Section of Pharmacology, University of Messina, Italy.
Pharmacol Res. 2010 Feb;61(2):116-20. doi: 10.1016/j.phrs.2009.07.014. Epub 2009 Aug 8.
Chest trauma is frequently followed by pulmonary contusion and sepsis. High mobility group box-1 (HMGB-1) is a late mediator of severe sepsis that has been associated with mortality under experimental conditions. We studied HMGB-1 mRNA expression in patients with lung injury and its relationship with the severity of trauma and survival. A total of 24 consecutive patients with chest trauma referring to the Intensive Care Unit of Messina University Hospital, were enrolled. Lung trauma was established on the basis of chest X-ray and computed tomography. Injury Severity Score (ISS), Revised Trauma Score (RTS) and Glasgow Coma Scale (GCS) were also assessed. Accordingly to these results 6 patients were considered as controls because of no penetrating trauma and low ISS. Blood and broncho-alveolar lavage fluid (BALF) from chest trauma patients were withdrawn at admission and 24h after the beginning of the standard therapeutic protocol. HMGB-1 mRNA increased significantly in blood (r=0.84) and BALF (r=0.87) from patients with trauma and pulmonary contusion and positively correlated with the severity of trauma (based on ISS and RTS) and the final outcome. HMGB-1 protein levels were also elevated in BALF macrophages from severe trauma patients compared to control subjects, furthermore TNF-alpha and its receptor TNFR-1 mRNA levels were also markedly increased in patients with a poor outcome respect to other subjects. Our study suggests that HMGB-1 may be an early indicator of poor clinical outcome in patients with chest trauma.
胸部创伤常伴有肺挫伤和脓毒症。高迁移率族蛋白 B1（HMGB-1）是严重脓毒症的晚期介质，在实验条件下与死亡率相关。我们研究了肺损伤患者中 HMGB-1 mRNA 的表达及其与创伤严重程度和存活率的关系。共纳入 24 例连续的胸部创伤患者，这些患者被转诊到墨西拿大学医院的重症监护病房。根据胸部 X 射线和计算机断层扫描确定肺损伤。还评估了损伤严重程度评分（ISS）、修订创伤评分（RTS）和格拉斯哥昏迷评分（GCS）。根据这些结果，由于没有穿透性创伤和较低的 ISS，6 名患者被认为是对照组。在开始标准治疗方案后，从胸部创伤患者中抽取血液和支气管肺泡灌洗液（BALF）。入院时和标准治疗方案开始后 24 小时，从创伤和肺挫伤患者的血液（r=0.84）和 BALF（r=0.87）中提取 HMGB-1 mRNA。HMGB-1 mRNA 水平与创伤严重程度（基于 ISS 和 RTS）和最终结果呈正相关。与对照组相比，严重创伤患者的 BALF 巨噬细胞中 HMGB-1 蛋白水平也升高，此外，与其他患者相比，预后不良患者的 TNF-α及其受体 TNFR-1 mRNA 水平也明显升高。我们的研究表明，HMGB-1 可能是胸部创伤患者临床预后不良的早期指标。
