手术创伤后单核细胞-血小板黏附、单核细胞活化功能的表达

The expression of CD42a^＋/CD14^＋＋ ,HLADR ^＋/CD14^＋ after surgical trauma

目的动态测定单核细胞-血小板黏附（CD42a^＋／CD14^＋）、单核细胞活化功能（HLADR^＋／CD14^＋）以观察手术创伤后炎症反应和免疫功能，并评价其临床意义。方法设计自身前后对照试验，采集22例择期骨科手术患者血液，用流式细胞术测定其术前及术中、术后多个时点CIM2a^＋／CD14^＋和HLADR^＋／CD14^＋的表达，同时检测PLT和WBC计数；观察组术前1天与健康志愿者（20例）进行对照。结果与T1时刻比较，HLADR^＋／CD14^＋于T2时刻开始明显下降，于T4时刻至最低35．7±8．2，后逐渐回升（P〈0．01），差异有统计学意义（P〈0．05）；与T1时刻比较，CD42a^＋／CD14^＋于T2时刻均开始上升，于T4时刻至最高29．9±5．0，后逐渐下降（P〈0．01）；CD42a^＋／CD14^＋（％）与PLT、WBC均为正相关（r值分别为0．890和0．814），差异有统计学意义（P〈0．01）。与对照组比较，观察组术前1d各指标差异无统计学意义（P〉0．05）。结论HLADR^＋／CD14^＋、CD42a^＋／CD14^＋是反映术后免疫功能和炎症反应之早期的、灵敏的、可预见的指标。

Objective To study the immune function and inflammatory reaction by monitoring the expression of CD42a^＋/CD14^＋ and HLADR ^＋/CD14^ ＋ continuously after surgical trauma and to discuss its clinical implications. Methods A self pair-matching experiment was designed and 22 patients with orthopedics operation were chosen. The expression of CD42a^＋/CD14^＋,HLADR^ ＋/CD14^＋ was detected by flow eytometry,and the count of PLT and WBC was detected also. Results Compared to T1 ,the expression of HLADR^＋/CD14^ ＋ was down-regnlated significantly from T2 and reached minimum at T4 （35.7 ±8.2） ; then the expression of HLADR ^＋/CD14^＋ was up-regnlated gradually（P 〈 0.01 ）. Compared to T1, the expression of CD42a^＋/CD14^＋was up-regulated from T2 and reached maximum at T4 （29.9±5.0） ;then the expression of CD42a^＋/CD14^＋ was down-regulated gradually （P 〈 0.01 ）. Compared to T1, the expression of WBC was up-regulated significantly from T2 and reached maximum at T3 （P 〈 0.01 ） ;then the expression of WBC was down-regnlated gradually. The expression tendency of CD42a^＋/CD14^＋, PLT and WBC showed a transparent relativity （ P 〈 0.01 ）. Compared to control group,inspection items had no statistically significant difference in observation group. Conclusion The expression of CD42a^＋/CD14^＋ and HLADR ^＋/CD14 ^＋ can reflect the immune function and inflammatory reaction inchoately and sensitively and has prediction after surgical trauma.