老年MODS患者免疫功能特点及其与病情转归的关系

Characteristics of immune function in elderly patients with MODS and its relationship with illness prognosis

目的探讨老年多器官功能障碍综合征(MODS)患者免疫功能特点及其与病情严重程度的关系。方法 50例MODS患者(MODS组)中,老年患者26例,非老年患者24例;另选取老年和非老年健康体检者各20例作为对照组。采用流式细胞术测定入院第1、5天人类白细胞抗原(HLA)-DR CD14^(+)比例,ELISA法检测TNF-α水平,并进行急性生理学及慢性健康状况Ⅱ(APACHEⅡ)评分。结果 MODS组与对照组相同年龄段HLA-DR CD14^(+)比例、TNF-α水平及APACHEⅡ评分比较均有统计学差异(P<0.05)。与入院第1天相比,MODS组非老年患者入院第5天HLA-DR CD14^(+)比例、TNF-α水平升高,且APACHEⅡ评分降低(P<0.05);而老年患者TNF-α水平降低,APACHEⅡ评分增加(P<0.05),HLA-DR CD14^(+)比例无明显变化(P>0.05)。与非老年患者相比,MODS组老年患者入院第5天HLA-DR CD14^(+)比例、TNF-α水平降低,APACHEⅡ评分增加(P<0.05)。MODS组病情未好转与病情好转老年患者HLA-DR CD14^(+)比例、TNF-α水平及APACHEⅡ评分比较均有统计学差异(P<0.05)。结论 MODS患者均存在不同程度的免疫功能障碍,其中老年患者免疫功能更难以恢复,免疫功能与病情严重程度及病情转归密切相关。

Objective To investigate the characteristics of immune function in elderly patients with multiple organ dysfunction syndrome(MODS) and its relationship with the illness prognosis.Methods Of 50 patients with MODS(group M),26 cases were elderly patients and 24 cases were non-elderly patients.Another 20 elderly and 20 non-elderly healthy people were selected as the controls(group C).The proportion of human leukocyte antigen(HLA)-DR CD14^(+) on the 1st and 5th day after admission was determined by flow cytometry.The level of TNF-α was detected by ELISA method,and the acute physiology and chronic health evaluation scoring systemⅡ(APACHEⅡ) scores were recorded.Results There were statistical differences in the proportion of HLA-DR CD14^(+),level of TNF-α and APACHEⅡ score between groups of M and C in the same age(P<0.05).Compared with the 1st day after admission,the proportion of HLA-DR CD14^(+) and level of TNF-α were increased,and APACHE Ⅱ score was decreased on the 5th day after admission in the non-elderly patients of group M(P<0.05),whereas the level of TNF-α was decreased and APACHEⅡ score was increased(P<0.05),but the proportion of HLA-DR CD14^(+) was not obviously changed in the elderly patients of group M(P>0.05).Compared with the non-elderly patients,the proportion of HLA-DR CD14^(+) and level of TNF-α were decreased,while APACHEⅡ score was increased on the 5th day after admission in the elderly patients of group M(P<0.05).Moreover,there were statistical differences in the proportion of HLA-DR CD14^(+),level of TNF-α and APACHEⅡ score between the elderly patients with and without improved conditions of group M(P<0.05).Conclusion There are varying degrees of immune dysfunction in the patients with MODS.The immune function is more difficult to recover in the elderly patients,which is closely related to the severity and prognosis of disease.