脓毒症患者CD_(14)^+单核细胞人类白细胞抗原-DR表达的观察

Observation of the expression of CD_(14)^+ monocyte human leukocyte antigen DR in septic patients

目的通过研究脓毒症患者静脉血CD14+单核细胞人类白细胞抗原-DR(HLA-DR)表达百分率的变化,评价患者的免疫状态及与疾病的严重程度和预后的关系。方法在患者被诊断为脓毒症后的第1、4、7、14、28天或出ICU及死亡前最后一次抽取静脉血,用流式细胞仪测定CD14+单核细胞HLA-DR表达百分率及当天的APACHEⅡ评分和SOFA评分,至脓毒症消失。结果18例患者存活,26例死亡。从第4天开始,存活组CD14+单核细胞HLA-DR表达均高于死亡组(P<0.001)。第1天、第4天CD14+单核细胞HLA-DR表达>30%者生存率均明显高于表达<30%者。CD14+单核细胞HLA-DR表达与APACHEⅡ评分、SOFA评分均存在负相关。结论脓毒症患者CD14+单核细胞HLA-DR表达持续低下可提示患者处于免疫抑制状态。检测CD14+单核细胞HLA-DR表达可用于判断脓毒症患者病情的严重程度和评估预后。

Objective To monitor the changes of the expression of CD14^＋ monocyte human leukocyte antigen DR（ HLA--DR） in septic patients and evaluate their immunological condition, relationship between severity of illness, prognosis and CD14^＋ monocyte HLA--DR. Methods After the diagnosis of sepsis was made, patients＇APACHE H-scores, SOFA scores and CD14^＋ monocyte HLA--DR were determined in the 1st, 4th, 7th, 14th and 28th days or the last time in ICU. Results Total1y,44 patients were enrolled in this study. Among them 18 survived and 26 died. From the 4th day, the expression of CD14^＋ monocyte HLA--DR in the survivors were significantly higher than that in the dead （P〈0.001） . Survival rate was greatly higher when CD14^＋ monocyte HLA--DR was 〉30% in the 1st and 4th daies. There was a negative correlation between CD14^＋ monocyte HLA--DR and APACHEll scores, SOFA scores. Conclusions Persistent low level of the expression of CD14^＋ monocyte HLA--DR in septic patients show the patients were in the states of immunosuppression. Detection the expression of CD14^＋ monocyte HLA-DR can be used to evaluate the severity of disease and predict prognosis in sepsis.