老年脓毒症患者单核细胞人白细胞抗原DR表达的变化及意义

Monocyte human leukocyte antigen-DR expression in elderly patients with sepsis

目的探讨老年脓毒症患者外周血单核细胞(PBMC)人白细胞抗原DR(HLA-DR)表达的变化及临床意义。方法213例老年住院患者按美国胸科医师协会/危重病医学会的定义分为非脓毒症组(A组)、脓毒症组(B组)、严重脓毒症组(C组)、脓毒症休克组(D组),另设60例健康体检者为对照组;用流式细胞仪检测每个人的PBMC表面HLA-DR分子的表达,并比较各组之间的差别。结果A组及D组患者PBMC表面HLA-DR阳性率与健康体检者相比,A组明显偏高,D组明显偏低,差异均具有统计学意义;B组及C组患者HLA-DR阳性率与健康体检者相比,差异无统计学意义;A组、B组、C组、D组四组之间相比,其PBMC表面HLA-DR阳性率的差异有统计学意义(P<0.01),按各组HLA-DR阳性率由低至高排序:D组(32.74±13.4)%<C组(61.9±14.29)%<B组(69.99±12.8)%<A组(85.06±15.37)%。结论①非脓毒症老年患者,尽管伴有多器官疾病以及反复或长期住院,其PBMC表面HLA-DR的表达并不降低;②在脓毒症及严重脓毒症老年患者中,HLA-DR的监测不是敏感指标;③HLA-DR的表达明显降低,可作为老年脓毒症休克期患者的特异性指标。

Objective To investigate the changes of human leukocyte antigen DR （HLA-DR） expression in the monocytes of elderly patients with sepsis. Methods A total of 213 elderly patients were divided into 4 groups according to the criteria defined by the American College of Chest Physicians/ Society of Critical Care Medicine （ACCP/SCCM）, namely the non-sepsis group （group A）, sepsis group （group B）, severe sepsis group （group C） and septic shock group （group D）. Another 60 healthy subjects were recruited as the control group. HLA-DR expression in the monocytes from each subject was determined by flow cytometry, and the HLA-DR levels were compared between the groups. Results Compared with that of the healthy control, HLA-DR expression was significantly increased in group A and lowered in group D. No significant differences were found between the control group and groups B and C. HLA-DR expression was significantly different between groups A, B, C, and D （P〈0.01）, increasing in the order of group D （32.74±13.4）%, group C （61.9±14.29）%, group B （69.99±12.8）%, and group A （85.06±15.37）%. Conclusions Although with multiple organ diseases and repeated or long-term hospitalization, the non-septic elderly patients do not show lowered expression of HLA-DR. In the elderly patients with Sepsis and severe sepsis, HLA-DR expression is not a sensitive index, but obviously lowered HLA-DR expression may serve as a specific indicator in elderly patients with septic shock.