Milić Ljiljana, Grigorov Ilijana, Krstić Slobodan, Ćeranić Miljan S, Jovanović Bojan, Stevanović Jelena, Peško Predrag
Clinic for Emergency Surgery, Emergency Center, University Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia.
Department of Molecular Biology, Institute for Biological Research, Belgrade, Serbia.
J Med Biochem. 2017 Jan 25;36(1):44-53. doi: 10.1515/jomb-2016-0016. eCollection 2017 Jan.
Intra-abdominal infection in secondary peritonitis drives as excessive production of inflammatory mediators and the development of systemic inflammatory response syndrome (SIRS) or sepsis. Finding a specific marker to distinguish SIRS from sepsis would be of immense clinical importance for the therapeutic approach. It is assumed that high-mobility group box 1 protein (HMGB1) could be such a marker. In this study, we examined the time course changes in the blood levels of HMGB1, C-reactive protein (CRP), procalcitonin (PCT) and serum amyloid A (SAA) in patients with secondary peritonitis who developed SIRS or sepsis.
In our study, we evaluated 100 patients with diffuse secondary peritonitis who developed SIRS or sepsis (SIRS and SEPSIS group) and 30 patients with inguinal hernia as a control group. Serum levels of HMGB1, CRP, PCT, and SAA were determined on admission in all the patients, and monitored daily in patients with peritonitis until discharge from hospital.
Preoperative HMGB1, CRP, PCT and SAA levels were statistically highly significantly increased in patients with peritonitis compared to patients with inguinal hernia, and significantly higher in patients with sepsis compared to those with SIRS. All four inflammatory markers changed significantly during the follow-up. It is interesting that the patterns of change of HMGB1 and SAA over time were distinctive for SIRS and SEPSIS groups.
HMGB1 and SAA temporal patterns might be useful in distinguishing sepsis from noninfectious SIRS in secondary peritonitis.
继发性腹膜炎中的腹腔内感染会引发炎症介质的过度产生以及全身炎症反应综合征（SIRS）或脓毒症的发展。找到一种区分SIRS和脓毒症的特异性标志物对于治疗方法具有极其重要的临床意义。假定高迁移率族蛋白B1（HMGB1）可能是这样一种标志物。在本研究中，我们检测了发生SIRS或脓毒症的继发性腹膜炎患者血液中HMGB1、C反应蛋白（CRP）、降钙素原（PCT）和血清淀粉样蛋白A（SAA）水平的时间进程变化。
在我们的研究中，我们评估了100例发生SIRS或脓毒症的弥漫性继发性腹膜炎患者（SIRS和脓毒症组）以及30例腹股沟疝患者作为对照组。在所有患者入院时测定HMGB1、CRP、PCT和SAA的血清水平，并对腹膜炎患者每天进行监测直至出院。
与腹股沟疝患者相比，腹膜炎患者术前HMGB1、CRP、PCT和SAA水平在统计学上显著升高，与SIRS患者相比，脓毒症患者的这些水平显著更高。在随访期间，所有四种炎症标志物均发生了显著变化。有趣的是，HMGB1和SAA随时间的变化模式在SIRS组和脓毒症组中有所不同。
HMGBl和SAA随时间变化的模式可能有助于区分继发性腹膜炎中的脓毒症和非感染性SIRS。
