严重烧伤患者外周血树突状细胞表型测定及其意义

Characterization and biological significance of peripheral blood dendritic cell subsets in patients with severe burn

目的了解严重烧伤患者外周血树突状细胞(DC)功能变化。方法对12例烧伤面积60%～99%的烧伤患者,分别于伤后第1、2、3、4周取外周静脉血分离培养 DC,单克隆抗体标记后,采用流式细胞仪测定 DC 表型组织相容性抗原(HLA)-DR、CD80、CD83、CD86、CD14、CD11C 的表达水平。10例健康志愿者外周血 DC 作为对照组。结果在伤后1、2、3、4周烧伤患者外周血 DC 表面标记表达的 HLA-DR 分别为62.1%±8.4%、65.0%±6.2%、68.4%±5.7%、75.4%±8.4%,对照组为93.9%±2.2%(均 P<0.05);CD80为12.9%±3.7%、14.7%±2.5%、16.1%±4.2%、16.2%±4.8%,对照组24.3%±11.6%(均 P<0.001);CD83为15.1%±4.2%、15.1%±4.0%、22.2%±7.7%、21.3%±7.0%,对照组28.1%±5.1%(均 P<0.001);CD86为69.2%±7.1%、70.5%±5.4%、75.1%±6.1%、79.6%±6.4%,对照组84.3%±8.2%(P<0.001),它们较对照组阳性表达率明显下降。CD14的阳性表达率为12.7%±1.9%,12.0%±1.5%,11.3%±1.3%,9.3%±1.7%,较对照组(7.3%±1.5%)则显著升高(P<0.001);CD11c 的阳性表达率为86.8%±6.1%、89.5%±5.1%、91.3%±2.8%、89.4%±4.0%,较对照组(92.6%±3.8%)虽有降低,但差异无统计学意义(均 P>0.05)。HLA-DR 阳性表达率从伤后第4周始有升高趋势,但仍明显低于正常对照组(P<0.05)。结论严重烧伤患者伤后外周血树突状细胞功能下降,是机体免疫系统功能抑制的重要部分,也是烧伤后引起全身感染的一个重要原因。

Objective To investigate the characteristics of dentritic cells （DCs） in patients with severe burn. Methods Peripheral blood samples were obtained from 12 patients with severe burn 1,2, 3, and 4 weeks after burn, and from 10 healthy donors as controls. Monouclear cells were isolated, and GMCSF 1000 and IL-4 were used to induce the transformation of DCs. Mature DCs were harvested and underwent flow cytometry to detect the expression of HLA-DR, CD80, CD83, CD86, CD14, and CD11c. Result 1,2, 3 , and 4 weeks after burn, the expression levels of HLA-DR were 62. 1% ± 8.4%, 65.0% ±6.2% ,68.4% ± 5.7%, and 75.4% ± 8.4% respectively; the expression levels of CDS0 were 12.9% ± 3.7%, 14.7% ± 2.5%, 16. 1% ± 4.2%, and 16.2% ± 4.8% ; the expression levels of CD83 were 15.1% ±4.2% ,15.1% ±4.0% ,22.2% ±7.7% ,and 21.3% ±7.0% respectively; the expression levels of CD86 were 69.2% ±7.1% ,70.5% ±5.4% ,75.1% ± 6.1% ,and 79.6% ± 6.4% respectively, all significantly lower than that of the control group （84.3% ± 8.2% , all P 〈 0.001 ）. 1,2,3 , and 4 weeks after burn, the expression levels of CD14 in the DCs of the severe burn patients were 12.7% ± 1.9%, 12.0% ± 1.5% , 11.3% ± 1.3%, and 9.3% ± 1.7% respectively, all significantly higher than that of the control group（7.3% ± 1.5 %, P 〈 0.001 ）. 1,2,3 , and 4 weeks after burn, the expression levels of CD11 c in the DCs of the severe burn patients were 86. 8% ±6. 1%,89.5% ±5. 1%,91.3% ±2.8%,and 89.4% ±4.0% respectively, a little lower than that of the control group, however, without significant difference （92.6% ± 3.8 %, P 〉 0.05 ）. Conclusion The functions of DCs in the patients with severe burn are declined, which may partly contribute to infection after burn.