动态监测重症监护室患者HLA-DR+/CD14+变化的临床意义

Clinical significance of dynamic monitoring HLA-DR+/CD14+ expression of ICU patients

目的在重症监护室(ICU)患者中动态监测外周血中人类白细胞抗原(HLA)-DR+/CD14+、CD14+的表达,并评价HLA-DR+/CD14+的临床意义。方法应用流式细胞术,测定入院后第1、3、7、14天ICU患者外周血中HLA-DR+/CD14+、CD14+的表达,并进行脓毒症相关性器官衰竭(SOFA)评分。结果入院后动态监测第1天,两组HLA-DR+/CD14+表达差异无统计学意义(t=0.86,P>0.05);第3天、第7天和第14天时存活组HLA-DR+/CD14+表达高于死亡组,差异均有统计学意义(t分别=3.34、6.61、7.60,P均<0.05);第7天和第14天时存活组CD14+表达高于死亡组,差异均有统计学意义(t分别=3.46、2.56,P均<0.05);SOFA评分第7天和第14天时低于死亡组,差异均有统计学意义(t分别=2.08、2.53,P均<0.05)。结论单核细胞活化功能表达持续低下可提示机体处于免疫抑制状态,动态监测HLA-DR+/CD14+是监测患者免疫功能的早期、连续的方法。

Objective To explore the expression of HLA-DR＋/CD14＋, CD14＋ and evaluate the clinical significance of HLA-DR＋/CD14＋ in ICU patients. Methods The expression of HLA-DR＋/CD14＋, CD14 from the peripheral blood of ICU patients on the 1st, 3th, 7th, 14th days were measured by flow cytometry. The SOFA score was calculated. Results The HLA-DR ＋/CD14 ＋ expression of two groups had no statistical significance on the first day of monitoring （t=0.86 ,P〉 0.05）. The expression of HLA-DR＋/CD14＋ of the survivor group was significantly higher than that of the death group on the 3th day,7th day and 14th day （t=3.34, 6.61, 7.60, P〈0.05）. The expression of CD14＋ of the survivor group was higher than that of the death group on the 7th day and 14th day（t=3.46,2.56, P〈0.05）. The score of SOFA of the survivor group was lower than that of the death group on the 7th day and 14th day（t=2.08,2.53, P〈0.05）. Conclusions The con- tinuously low expression of monocyte HI_,A-DR in the ICU patients suggest that body was in a state of immune paralysis. Dy- namic monitoring the expression of HLA-DR＋/CD14＋ could be used to evaluate immune function early and continuously.