动态监测脓毒症患者单核细胞功能的临床意义

The clinical significance of continuous monitoring of monocytes function in septic patients

目的动态监测患者出现脓毒症后外周血单核细胞功能和器官功能的变化,并评价其临床意义。方法在患者被诊断为脓毒症后的第1、3、5、7天测定其血清TNFα、IL10浓度及其外周血单核细胞百分率、单核细胞表面CD14与ICAM1的平均荧光强度(CD14MFI与ICAM1MFI)、当天的脓毒症相关性器官衰竭(SOFA)总评分及其预后。结果在20例持续存在7d以上的脓毒症患者中,10例存活,10例死亡;存活组外周血单核细胞百分率、CD14MFI水平在第5天明显升高,并高于死亡组的对应值(P<0.05),SOFA总评分明显下降;两组外周血单核细胞ICAM1MFI水平、血清TNFα和IL10水平均没有发生明显变化(P>0.05)。结论单核细胞功能改善时,SOFA总评分下降,器官功能好转;单核细胞ICAM1MFI、血清TNFα和IL10的动态变化不能反映患者疾病的演变和预后。

Objective To continuously monitor changes of monocytes function and multiple organ function in septic patients, and to evaluate the clinical significance. Methods Percentage of peripheral blood monocytes, mean fluorescence intensity （MFI） of CD14 and ICAM-1 （CD14MFI, ICAM-1MFI） on the surface of monocytes, serum TNF-α and IL-10 of the patients were measured at 1, 3, 5, 7 days after they were diagnosed with sepsis. The total score of sepsis-related organ failure assessment （SOFA） was counted. Results 10 patients survived and other 10 died in the 20 patients with sepsis lasting more than 7 days. Percentage of CD14 and CD14MFI increased at 5 day in the surviving group, while SOFA was decreased. ICAM-IMFI, monoeytes, serum TNF-α and IL-10 at 1, 3, 5, 7 days showed no statistical significance between surviving group and the dead group （ P 〉 0.05）. Conclusions The patients with sepsis lasting more than 7 days had high mortality （50%）. While percentage of CDI4 and CDI4MFI of peripheral blood are increased, the total scores of SOFA and numbers of MOF are decreased. The improvement of monocytes function indicates good prognosis. The changes of expression of ICAM-1, serum TNF-α and IL-10 can not reflect prognosis in septic patients.