重症急性胰腺炎患者外周血单核细胞HLA-DR的表达及其临床意义

The clinical significance of HLA-DR expression in peripheral blood mononuclear cell in patients with severe acute pancreatitis

目的研究重症急性胰腺炎(SAP)患者外周血HLA-DR表达及其临床意义。方法收集55例胰腺炎患者,25例SAP、30例轻症急性胰腺炎(MAP),采用流式细胞术检测入院时、48 h及第7天外周血单核细胞人类白细胞抗原-DR(human leukocyteantigen-DR,HLA-DR)表达。以30例同期健康体检者做正常对照。结果①与正常对照组及MAP组相比,SAP组外周血单核细胞HLA-DR表达在整个观察期内均明显降低(P<0.01),与非脓毒症组相比,合并脓毒症者降低更显著(P<0.01),至第7天仍无明显回升;而MAP组HLA-DR表达呈一过性下降,48 h起明显回升,第7天接近正常。②胰腺炎患者外周血单核细胞HLA-DR表达与Ranson评分、APACHE-Ⅱ评分呈负相关(R=-0.747、-0.878,均P<0.01)。③受试者工作特征曲线(receiver operator characteristiccurve,ROC曲线)显示HLA-DR预测脓毒症优于APACHE-Ⅱ评分及Ranson评分。结论 SAP患者外周血单核细胞抗原递呈功能障碍,检测外周血单核细胞HLA-DR表达有助于判断患者病情严重程度、机体免疫状态及预测脓毒症的发生。

To evaluate the clinical significance of human leukocyte antigen-DR （HLA-DR） expression in peripheral blood mononuclear cell in patients with severe acute pancreatitis （SAP）, patients with acute pancreatitis were selected and divided into two groups： 25 cases with SAP, 30 cases with mild acute pancreatitis （MAP）, and thirty healthy people were selected as control group. Flow cytometry showed that compared with MAP and control group, expression of HLA-DR was decreased significantly in SAP group during the whole observation period of 7 days （all P〈 0.01）, and these changes in group of SAP with sepsis were more significant than those of SAP without sepsis （P〈0.01）. While HLA-DR level in MAP group decreased transiently, then picked up at 48 h, and returned to normal level at the 7~ day. In patients with acute pancreatitis, HLA-DR expression was correlated negatively with Ranson score and APACHE- Ⅱ score （R =-0.747, -0.878, all P 〈 0.01）. Receiver operating characteristic curve （ROC） showed that HLA - DR is superior to APACHE- Ⅱ score and Ranson score in predicting sepsis in patients with acute pancreatitis. The result suggested that peripheral blood mononuclear cell antigen presenting dysfunction is existed in SAP patients, thus detection of HLA-DR expression level in peripheral blood mononuclear cell is helpful to identify disease severity, immune status and predict sepsis occurrence of SAP patients.