高迁移率族蛋白B1作为脓毒症生物标记物临床应用进展

蒋大明.高迁移率族蛋白B1作为脓毒症生物标记物临床应用进展[J].内科急危重症杂志,2026,32(1):81-85

DOI：10.11768/nkjwzzzz20260118

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作者	单位	E-mail
蒋大明		webtan1981@gmail.com

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中文摘要:

摘要高迁移率族蛋白B1（HMGB1）是一种典型的损伤相关分子模式蛋白，是在内毒素血症的最初24 h内从组织中释放的主要警报素之一。脓毒症时，HMGB1易位到细胞外后，成为一个警告信号发挥作用，并通过2种基本独立的方式诱发炎症。HMGB1在脓毒症细胞因子风暴的中心发挥作用。研究显示脓毒症者HMGB1水平较非脓毒症患者显著升高，在以4.2 ng/mL为截断值时，HMGB1诊断脓毒症的灵敏度和特异性分别为79.4%和45%；而以7ng/mL为截断值时，诊断脓毒症的灵敏度和特异性分别为60%和59.2%。多项研究表明，HMGB1与器官功能障碍评分显著相关，当脓毒症继发急性肺损伤、急性肾损伤或弥散性血管内凝血时，HMGB1进一步升高，提示HMGB1与脓毒症病情严重程度相关。研究显示初始HMGB-1水平与脓毒症30 d内死亡率存在显著关联，对HMGB1 的动态监测可以更好地评估脓毒症的临床预后。目前，尚需要更多的研究来确定监测时间点及参考值，以便临床使用HMGB1作为脓毒症诊断、严重程度和预后判断的生物标志物。

英文摘要:

Abstract High mobility group box 1 protein (HMGB1) is a typical damage-associated molecular pattern protein and one of the major alarmins released from tissues within the first 24 h of endotoxemia. During sepsis, HMGB1 translocates to the extracellular space and functions as a warning signal, inducing inflammation through two largely independent pathways. HMGB1 plays a central role in the cytokine storm of sepsis. Studies have shown that HMGB1 levels in sepsis patients are significantly higher than those in non-sepsis patients. When the cutoff value is 4.2 ng/mL, the sensitivity and specificity of HMGB1 for diagnosing sepsis are 79.4% and 45%, respectively; when the cutoff value is 7 ng/mL, the sensitivity and specificity are 60% and 59.2%, respectively. Multiple studies have demonstrated that HMGB1 is significantly correlated with organ dysfunction scores. When sepsis is complicated by acute lung injury, acute kidney injury, or disseminated intravascular coagulation, HMGB1 levels further increase, suggesting that HMGB1 is associated with the severity of sepsis. Research indicates that the initial HMGB1 level is significantly associated with the 30-day mortality rate of sepsis. Dynamic monitoring of HMGB1 can better evaluate the clinical prognosis of sepsis. Currently, more research is needed to determine the monitoring time points and reference values for the clinical use of HMGB1 as a biomarker for the diagnosis, severity assessment, and prognosis prediction of sepsis.