急性重症脑卒中患者单核细胞HLA-DR的表达变化与病情及感染的关系

Changes of human leukocyte antigen-DR expression on monocyte and its correlation with conditions and complicated infections in critically acute stroke patients

目的探讨急性重症脑卒中患者,外周血单核细胞人类白细胞抗原-DR(HLA-DR)的表达变化,及其与病情和感染并发症之间的关系。方法前瞻性研究连续入选的发病后<24h入住神经重症监护病房(NICU)的急性脑卒中患者,观察<2周的感染并发症及病情情况,采用流式细胞仪检测不同时间点外周血单核细胞HLA-DR表达;并记录不同时间点NIHSS、APACHEⅡ和GCS评分;设立同期住神经内科普通病房中的头晕患者(均经头颅MRI排除急性脑卒中)作为对照组。结果入选急性脑卒中患者53例,对照组患者39例,在观察的第1、2、4、6、14天,单核细胞HLA-DR表达,卒中组和对照组比较差异有统计学意义(P<0.01),缺血性卒中组和出血性卒中组之间差异无统计学意义,感染组和非感染组在第1、2天差异无统计学意义,但第4、6、14天差异有统计学意义(P<0.01);7例死亡患者HLA-DR表达进行性下降,第2、4天HLA-DR表达值与相应时间的NIHSS评分呈显著负相关,差异有统计学意义(P<0.01);而HLA-DR表达值与相应时间的GCS、APACHEⅡ评分无明确相关性。结论急性重症脑卒中患者发病后,早期即存在单核细胞免疫功能抑制,其程度与病情严重程度相关,单核细胞免疫抑制对卒中后感染的发生有促发作用,单核细胞免疫功能持续下降的患者预后不佳。

OBJECTIVE To investigate changes in human leucocyte antigen（HLA）-DR expression on peripheral monocytes,and determine the correlation with other conditions in critically-ill patients who suffered an acute stroke and infection complications.METHODS All patients were enrolled consecutively and admitted to NICU within 24 h after the onset of symptoms.Patients were followed in order to identify whether the infection developed or determine survival status within two weeks after the stroke,the patients in which acute stroke was excluded by head CT or MRI were admitted to general wards and were used as a control group.Blood samples were collected serially on day 1,2,4,6 and 14 after stroke,then monocyte HLA-DR expression was determined by flow cytometry.The NIHSS,APACHEⅡ and GCS scores were recorded over the course of observation.RESULTS A total of 53 subjects and 39 controls were enrolled in the study.On day 1,2,4,6 and 14,there was a significant difference in monocyte HLA-DR expression between stroke group and control group（all P0.001）,but no difference was found between ischemic stroke group and hemorrhagic stroke group（all P0.05）.The infection group compared with non-infection group did not exhibit a significant difference in HLA-DR expression on days 1 and 2（all P0.05）,but significant differences emerged on day 4,6 and 14（all P0.01）.On days 1 and 2 the HLA-DR expression in the survival group compared with death group,was not significantly different（all P0.05）,but differences became significant on day 4 and 6（P0.01）.A significant inverse correlation was found between NIHSS and HLA-DR on day 2 and 4 during the observation period（all P0.01）,but there was no significant negative correlation on day 1,6 or 14（all P0.05）.HLA-DR expression did not correlate with APACHEⅡ（all P0.05） or GCS（all P0.05） during the measurement period.CONCLUSION HLA-DR expression decreases and sustains a dynamic change and it is also related to the severity of patient＇s condition in the critically-ill and patients with stroke.Progressively persistent low monocyte HLA-DR expression is associated with a poor prognosis.The decline in HLA-DR expression contributes to infection in critically-acute stroke patients.