CD14^+单核细胞人白细胞DR抗原在脓毒症早期检测中的临床意义

Clinical value of monitoring CD14^+ monocyte human leukocyte antigen (locus) DR levels in the early stage of sepsis

目的探讨脓毒症早期免疫抑制状态的监测方法及与预后的关系。方法36例脓毒症患者入住重症监护室(ICU)当日,采用流式细胞仪检测其CD14+单核细胞人白细胞DR抗原(HLA DR)水平,同时进行急性生理学与慢性健康状况评分系统(APACHE)评分,通过相关分析比较两者评价脓毒症预后的临床价值。结果36例脓毒症患者入ICU时CD14+单核细胞HLA DR表达<30%者占16.67%(6/36例),APACHE评分为(24.17±4.45)分,两者之间的相关系数(r)=0.212,P=0.687;所有患者均死亡。CD14+单核细胞HLA DR表达<40%者占27.78%(10/36例),APACHE评分为(23.50±4.30)分,两者之间r=0.251,P=0.484;病死率为80%(8/10例)。结论CD14+单核细胞HLA DR表达<30%是免疫抑制的判断指标,对脓毒症预后的判断可能优于APACHE评分。脓毒症发病早期存在原发性免疫抑制,提示经典代偿性抗炎反应综合征(CARS)假说可能需要进一步补充和完善。

Objective To explore the relationship of monitoring CD14^＋ monocyte human leucocyte antigen （locus） DR （HLA - DR） and the outcome in the early stage of sepsis. Methods Thirty-six definitely diagnosed septic patients in intensive care unit （ICU） were included. CD14^＋ monocyte HLA- DR levels were detected by flow cytometer on the first day of the study, and acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） scores were evaluated. Their clinical values in predicting the outcome of the disease were assessed through correlation analysis. Results Among 36 sepsis patients CD14^＋ monocyte HLA - DR level〈30% was found in 6 patients （16.67%）. The average APACHE Ⅱ score was 24.17±4.45 （r=0. 212, P=0. 687）, all of them die, CD14^＋ monocyte HLA - DR level 〈40% was 27.78% （10/36）, the scores of APACHE I score was 23.50±4.30 （r=- 0. 0251, P=0.484）, and the mortality rate was 80% （8/10）. Conclusion CD14^＋ monocyte HLA- DR level 〈30% is an immunosuppressive index. In predicting the outcome of sepsis, it might be better than APACHE Ⅱ scores. Immunosuppression is primarily found in the early stage of sepsis, suggesting that the classical compensatory anti-inflammatory response syndrome （CARS） hypothesis needs to be revised and improved.