单核细胞HLA-DR和血乳酸在脓毒症新生儿的表达及预后关系

Expression of HLA-DR and blood lactic acid level in neonatal sepsis and their relation to prognosis of patients

目的观察脓毒症新生儿单核细胞HLA-DR和血乳酸水平的表达变化及其与脓毒症患儿预后的相关性。方法选取脓毒症新生儿62例(脓毒症组),根据住院治疗期间是否死亡,又分为存活亚组40例和死亡亚组22例;同时选取健康新生儿50例作为对照组,检测各组治疗前后HLA-DR表达率和血乳酸水平,采用ROC曲线分析HLA-DR表达率、血乳酸水平对脓毒症的诊断价值,并分析其及与预后的关系。结果治疗前脓毒症组患儿HLA-DR表达率明显低于对照组,血乳酸水平明显高于对照组,两组比较差异均有统计学意义(均P<0.05)。治疗24h后脓毒症组患儿HLA-DR表达率明显高于治疗前,血乳酸水平明显低于治疗前,治疗前后比较差异均有统计学意义(均P<0.05)。死亡亚组脓毒症患儿HLA-DR表达率明显低于存活亚组,血乳酸水平明显高于存活亚组,两组比较差异均有统计学意义(P<0.05)。HLA-DR表达率与血乳酸水平呈负相关(r=-8.41,P<0.05)。HLA-DR表达率和血乳酸预测脓毒症的AUC分别为0.904(95%CI:0.821~0.998)、0.748(95%CI:0.625~0.903)。多因素logistic回归分析显示△HLA-DR下降,△血乳酸升高是脓毒症患儿预后不良的独立危险因素(OR=2.204和2.306,均P<0.05)。结论脓毒症患儿HLA-DR表达率明显下降,血乳酸水平明显升高;两者联合检测可以提高诊断脓毒症的灵敏度;两者与脓毒症预后密切相关,可用来预测患儿预后情况。

Objective To investigate the expression of HLA-DR and blood lactic acid level in neonatal sepsis and their relation to prognosis of patients. Methods Sixty two neonatal patients with sepsis （sepsis group） admitted from February 2013 to December 2016 and 50 normal newborns （control group） were enrolled in the study. Among 62 patients, 22 died （fatal group） during the hospitalization and 40survived（survival group）. The blood lactic acid levels were measured and the expression of HLA-DR in peripheral mononuclear cells was detected before and after treatment, the ROC curve was applied to evaluate HLA-DR expression and blood lactate level in prognosis of neonatal sepsis. Results In patients with sepsis, the blood lactic acid level was significantly higher and expression of HLA-DR was lower than those of the control group before treatment（both P〈 0.05）. The blood lactic acid level was decreased and the HLA-DR expression was increased significantly 24h after the treatment （both P〈0.05）. The blood lactic acid level in fatal group was higher than those in the survival group and the expression rate of HLA-DR was lower than that of survival group （both P〈0.05）. The expression rate of HLA-DR was negatively correlated with blood lactate level （r=-8.41, P〈0.05）. The area under ROC curve （AUC） of HLA-DR and blood lactic acid in predicting outcomes of neonatal sepsis was 0.904 （95%C/：0.821-0.998） and 0.748 （95%C/：0.625-0.903）, respectively. Multivariate logistic regression analysis showed that the decreased AHLA-DR, increased the blood lactic acid were the independent risk factors of death in neonatal patients with sepsis （OR=2.204 和 2.306, both P〈0.05）. Conclusion The expression of HLA-DR is decreased and blood lactate level increased in neonatal patients with sepsis, both of which are closely related to the outcomes of sepsis and might be used for prognosis of patients.