多发伤病人外周血PMNs ICAM-1、LFA-1表达的变化及意义

Expression of ICAM-1,LFA-1 on the Peripheral PMNs in Patients with Multiple Injuries and Their Significance

目的观察多发伤病人外周血多形核中性粒细胞（PMNs）ICAM-1、LFA－1表达变化。方法使用流式细胞术分别检测37例多发伤病人入院时、伤后1、3、7天外周静脉血PMNsICAM-1、LFA－1的平均荧光通道（MFC）变化，13例健康志愿者作为对照组。结果多发伤病人PMNsICAM－1、LFA－1表达在创伤后各时相点上与对照组比较有显著差异（P＜0．001）。在伤后最初3天内，ISS≥16分组较ISS＜16分组明显增高（P＜0．01）。在伤后并发MODS、创伤性失血性休克的病人中，PMNsICAM-1、LFA-1表达较非MODS、创伤性失血性休克病人显著增高（P＜0．001）。结论严重创伤后细胞粘附分子I-CAM-1，LFA-1的上调表达与损伤严重程度相平行。其动态变化监测对伤情预后的判断可能具有重要的临床意义。

Objective To observe the changes of expression of intercellular adhesion molecule-1 (ICAM-1, CD54) and lymphocyte function-associated antigen-1 (LFA-1, CD11a/CD18 ) on peripheral polymorphonuclear neutrophils(PMNs) in patients with multiple injuries. Methods Thirty-seven patients with multiple injuries were included in this prospective study. Venous blood samples were collected at admission and 1, 3, 7 days after injury. ICAM-1, LFA-1 expression on PMNs was assayed by flow cytometry and compared with thirteen healthy volunteers(control group). Results PMNs ICALM-1, LFA-1 expression(A, B group) was significantly raised above control group in the study period(P< 0.001). The expression of ICAM-1, LFA-1 appeared to be higher in patients with ISS≥16 than in thae with ISS<16 within the first 3 days after injury (P<0. 01 ). In patients with multiple injuries who develoed multiple organ dysfunction syndrome(MODS) and complicated hemorrhage shock, PMNs ICAM-1, LFA-1 expression showed higher levels than in those without MODS and hemorrhage shock(P<0.001). Conclusion Posttraumatic neutrophils ICAM-1, LFA-1 expression is up-regulated immediately and the elevated levels are parallel to injury severity. Monitor of dynamic changes of cellular adhesion molecules may be benefit for predicting the prognosis after multiple trauma.