重症脓毒症患者外周血单核细胞膜结合CD14受体的表达与预后关系

Relationship between expression of membrance-associated CD14 on peripheral blood mononuclear cell with severe sepsis and clinical outcome

目的观察重症脓毒症患者外周血单核细胞（PBMC）膜结合CD14受体（mCD14）的表达变化与预后的关系。方法选取35例重症脓毒症患者和15例健康志愿者作为对照。按预后分为生存组（25例）和死亡组（10例），用流式细胞仪检测PBMC表面mCD14表达在病后不同时间的动态改变。结果生存组和死亡组发病后0小时急性生理学和慢性健康状况评分Ⅱ（APACHE-Ⅱ）、全身性感染相关器官功能衰竭评分（SOFA）分别为sOFA（18．93±9．37）分VS（20．75±8．6）分、SOFA（9．27±3．90）分VS（9．10±3．21）分（P〉0．05），发病后0、12、24和48小时PBMC表面mCD14表达2．61±1．59、2．93±1．92、3．05±1．73、4．14±1.99显著低于正常对照组5．64±1．79（P〈0．01），48和72小时逐渐升高4．14±1．99、4．51±2．08，但未达到正常对照水平（P〈0．05）。生存组与死亡组0、12、24、48和72小时mCD14表达3．14±1．95VS2．66±1．50、3．11±2．03VS3．45±2．01、3．66±1．87VS2．84±1．70、5．30±1．95VS3．51±1．55，第48～72小时生存组明显高于死亡组，组间（F=15．969，P〈0．01），不同时点（F=17．347，P〈0．01），组间·不同时点（F=29．138，P〈0．01）之间差异均有统计学意义。结论重症脓毒症患者外周血单核细胞mCD14表达与患者预后密切相关，动态监测其改变对重症脓毒症的转归有一定的预警意义。

Objective To observe the change of expression of membrance-associated CD14 （mCD14） of peripheral blood mononuclear cell （PBMC） with severe sepsis and its relation to clinical outcome. Methods Thirty-five patients with severe sepsis and fifteen healthy volunteers were selected in this experiment. Thirty-five patient were divided into survivors（ n =25） and non survivors （ n = 10 ）. The expression of mCD14 on PBMC was assayed with flow cytometry. Results The acute physiology and chronic health evaluation Ⅱ （APACHE-U） and sepsis related organ failure assessment （SOFA） were no significance between non survivors and survivors at 0 h （18. 93±9.37） scores vs （20.75±8. 6） scores,（9.27±3.90） scores vs （9. 10±3.21） scores（ P 〈0.05）. The expression of mCD14 on PBMC（2.61 ± 1.59,2.93 ± 1.92,3.05 5= 1.73） were significantly lower than healthy volunteers（5.64 ± 1.79） （ P 〈0.01 ）, but it was gradually higher （4.14 ± 1.99,4.51 ± 2.08） at 48-72 h,still it failed to return to the normal range（ P G0.05）. The expression of mCD14 on PBMC （3.14±1.95 vs 2.66 ±1.50,3.11 ± 2.03 vs 3.45± 2.01,3.66 ±1.87 vs 2.84 ± 1.70 ） were no significantly between non survivors and survivors at 0-24 h（ P 〉0.05）, but at 48-72 h it was significantly higher than non survivors（ P〈0.05）. The expression of mCD14 at 48-72 h was higher than 0-24 h in survivors（ P 〈0.05）, while it was no significance in non survivors between time spots（ P〉0.05）. Conclusion The expression of mCD14 on PBMC with severe sepsis shows close relation to the outcome. Monitoring the changing of mCD14 on PBMC has the benefit of mastering the severe sepsis progress.