外科术后危重患者单核细胞HLA-DR表达的临床研究

Study on monocyte HLA-DR expression in critically ill patients after surgery

目的研究外科术后危重患者外周血CD14+单核细胞HLA-DR的表达及动态变化与其预后的关系。方法应用流式细胞术检测并比较30例外科手术后呼吸机脱机困难而转入ICU的危重患者和28名同期体检健康者的外周血CD14+单核细胞HLA-DR的表达率。动态观察入ICU第1、4、7天单核细胞HLA-DR的表达率的变化,并记录APACHEⅡ评分、全身性感染相关性器官功能衰竭评分(SOFA)及28d的短期预后。结果与健康志愿者相比,外科术后危重患者外周血CD14+单核细胞HLA-DR的表达率降低(P<0·01)。入ICU第1天的HLA-DR表达率与SOFA、APACHEⅡ评分及预后无相关性。第7天HLA-DR表达率较第1天提高的患者其28d的短期预后较好(P<0·01)。结论外科术后危重患者外周血CD14+单核细胞HLA-DR的表达率较正常人降低;入ICU当天的单核细胞HLA-DR的表达率不能提示预后,而在治疗过程中,动态地观察外周血CD14+单核细胞HLA-DR的表达率才能对患者的预后作出正确的评估。

Objective To explore the HLA-DR expression on CD14^＋ monocyte in peripheral blood of critically ill patients after surgery and observe its relationship with prognosis of patients. Methods HLA- DR expression on CD14^＋ monocytes in peripheral blood was measured in critically ill patients after surgery （30 cases） by using flow cytometry on the day 1,4 and 7 after entered the ICU, and were compared with those in the healthy volunteers （28 cases ）. APACHE II score, sepsis-related organ failure assessment （SOFA） score, age, sex and 28 d prognosis were recorded. Results The HLA-DR expression on CD14^＋ monocyte in peripheral blood in critically ill patients after surgery were lower than that of healthy volunteers （P 〈 0. 01 ）. The CD14^＋ monocyte HLA-DR expression on day 1 after entered ICU was not correlated with APACHE Ⅱ score, SOFA and 28 d prognosis. However, compared with those with decreased HLA-DR expression, those with increased monocyte HLA-DR expression on day 7 had a better 28 d survival rate（ P 〈 0. 01 ）. Condusions In critically ill patients after surgery, the decreased HLA-DR expression on CD14^＋ monocyte in peripheral blood on day 1 after entered ICU could not be regarded as a prognostic parameter, but it is significative to monitor the increased expression of HLA-DR on CD14^＋ monocyte for evaluating the 28 d prognosis.