创伤患者单核细胞表面人白细胞抗原-DR表达变化及其临床意义  

Monocyte human leukocyte antigen-DR expression in trauma patients and its clinical significance

作　　者：王晓东[1] 李维勤[1] 虞文魁[1] 李宁[1] 黎介寿[1] 

机构地区：[1]南京大学医学院临床学院,南京军区南京总医院普通外科研究所,SICU,210002

出　　处：《中华创伤杂志》2006年第8期570-573,共4页Chinese Journal of Trauma

基　　金：军队"十五"科研基金重点资助项目(01Z011)

摘　　要：目的探讨创伤患者单核细胞表面人白细胞抗原-DR(HLA-DR)表达的变化规律及其与炎症反应的关系。方法采用流式细胞仪连续检测32例创伤患者[损伤严重度评分(ISS)＞16]伤后单核细胞HLA-DR的阳性分子的表达率,并据感染发生与否分组进行分析；同时检测白细胞介素(IL)-6和IL-10的变化。结果所有患者创伤后1 d单核细胞HLA-DR抗原为(73．67±7．32)%,显著低于正常值(P＜0．01),并于伤后4 d达到最低水平[(47．89±9．31)%]；合并感染并发症患者伤后1,2,4,7,14 d单核细胞HLA-DR抗原分别为(62．92±8．62)%、(45．34±5．96)%、(22．36±8．21)%、(25．14±5．17)%、(28．93±9．92)%,而无并发感染者分别为(75．32±6．53)%、(55．13±3．95)%、(53．21±5．36)%、(63．10±7．55)%、(88．34±8．07)%,相同时相两组比较,差异有统计学意义(P＜0．05,0．01)。创伤患者单核细胞HLA-DR表达与APACHEⅡ评分呈显著负相关(r=-0．435,P＜0．01)。创伤患者IL-10的变化和HLA- DR呈负相关,伤后2 d相关性最强(r=-0．782,P＜0．01)。结论(1)创伤后患者早期就存在免疫抑制状态；免疫抑制程度与病情严重度密切相关；(2)创伤患者CD14^+单核细胞的HLA-DR下降与创伤后感染有关；(3)创伤患者CD14^+单核细胞的HLA-DR的变化与血浆IL-10的变化有关。Objective To observe the changes of human leukocyte antigen DR （HLA-DR） expression in monoeytes of trauma patients and its prediction value of infection complications. Methods Thirty-two trauma patients with injury severity score （ISS） 〉 16 were divided into two groups： the infection group and the non-infection group. Blood samples were collected serially at days 1,2, 4, 7, 14 after trauma. Monoeyte HLA-DR expression was determined by flow eytometry. The serum eytokines were measured by ELISA. Results The HLA-DR expression of monoeytes was reduced in trauma patients （73.67±7.32, P 〈0.01 ）. The lowest level of HLA-DR was recorded on day 4 after trauma （47.89 ± 9.31 ） % （ P 〈 0.01 ）. Subsequently HLA-DR expression on monoeytes increased gradually. During the whole observation, the HLA - DR expression was significantly decreased in the infection group versus the non-infection group on days 1, 2, 4, 7 and 14（ 62.92 ± 8.62 vs. 75.32 ± 6.53, P 〈 0.05 ; 45.34 ± 5.96 vs. 55.13 ±3.95, P〈0.05; 22.36±8.21 vs. 53.21 ±5.36, P〈0.01; 25.14±5.17 vs. 63.10 ± 7.55, P 〈 0.01 ; 28.93 ± 9.92 vs. 88.34 ± 8.07, P 〈 0.01 ）, respectively. A statistically significant inverse correlation was found between the HLA-DR expression and APACHE Ⅱ score during the obsevation days. And a statistically significant inverse correlation was found between the I-ILA-DR expression and the serum interleukin 10 （IL-10） during the observation days. Conclusion 1. Trauma patients are in the immunosuppressive status in the early time, and the degree of immunosuppression is correlative with trauma severity of the patients. 2. The decrease of HLA-DR expression contributes to trauma patients＇ infection. 3. The changes of monoeyte HLA-DR relate with serum IL-10 level.

关 键 词：脓毒症 单核细胞 HLA—DR抗原 免疫抑制 

分 类 号：R641[医药卫生—外科学]