外周血单核细胞膜CD14表达预测脓毒症患者预后的研究

The index of membrane CD14 on circulating monocyte is a good predictor for sepsis outcome

目的通过对脓毒症患者外周血单核细胞膜CD14表达的动态观察,探讨CD14表达的动态监测在脓毒症预后预测中的作用。方法对32例成人脓毒症患者外周血单核细胞膜CD14进行动态检测,并与20名健康志愿者进行对照。在脓毒症确诊后的第1天、第3天、第7天及第14天用流式细胞术进行外周血单核细胞膜CD14的检测,采用Cellquest软件分析有核细胞中CD14阳性率(CD14%),CD14平均荧光强度(CD14MFI),同时进行白细胞计数(WBC),并计算CD14指数(CD14IND,CD14%×CD14MFI×WBC)。结果有核细胞中CD14%,CD14MFI,CD14IND明显低于健康对照组。脓毒症患者中死亡组CD14%、CD14MFI、CD14IND均低于存活组。以CD14%≤1.20,CD14MFI≤35.94,CD14IND≤4.40作为脓毒症患者预后预测的临界值,其敏感性和特异性分别为80.0%和90.9%,90.0%和90.9%,90.0%和95.5%。结论外周血单核细胞膜CD14的表达与脓毒症患者预后密切相关。动态监测CD14可预测脓毒症患者的预后。

Objective To find out how to predict the outcome of sepsis with membrane CD14 on circulating monocytes by dynamically monitoring the expression of membrane CD14 on circulating monocytes. Methods A total of 32 adults with sepsis and 20 adult healthy volunteers were included in the study. A double-immunofluorescent whole-blood technique was used to investigate membrane CD14 and HLA-DR expression on the 1 st,3rd ,Sth ,7th,and 14th day after sepsis was confirmed. White blood cell count （ WBC ） was simultaneously performed. Results The mean levels of percentages of CD14-positive cells（CD14% ） ,mean fluorescent intensity of CDI4（CD14MFI） ,CDI4 index（CD14IND,determined as CD14% × CD14MFI× WBC）of the sepsis group were lower than those of health control group, respectively. When CD14% ≤ 1.20, CD14MFI ≤35.94, CD14IND ≤ 4.40 were used as cutoffs to predict the outcome of the patients, sensitivity and specificity were 80. 0% and 90. 9% ,90. 0% and 90. 9% ,90. 0% and 95.5%, respectively. Conclusions CD14%, CD14MFI, CD14IND correlated strongly with the outcome of sepsis patients. Dynamically monitoring the expression of CD14 during the whole septic episode is useful in outcome predicting for sepsis patients.