严重烧伤患者人白细胞抗原DR定量表达的临床意义  

Clinical significance of changes in quantitative expression of human leukocyte antigen DR in severely burned patients

作　　者：董宁[1] 姚咏明[1] 曹玉珏 贺立新 柴家科[1] 徐姗[1] 盛志勇[1] 

机构地区：[1]解放军总医院第一附属医院全军烧伤研究所,北京100037 [2]北京佑安门医院烧伤科

出　　处：《中华外科杂志》2007年第11期766-769,共4页Chinese Journal of Surgery

基　　金：国家重点基础研究发展规划资助项目(2005CB522602);国家杰出青年科学基金(30125020);北京市科技计划重大资助项目(H020920020530);首都医学发展基金重点资助项目(2003-2023)

摘　　要：目的探讨严重烧伤患者人白细胞抗原 DR(HLA-DR)定量表达的变化规律及其临床意义。方法采集77例烧伤大于体表总面积30%的患者的血样,通过流式细胞技术对患者烧伤后不同时段 CD14^+单核细胞表面 HLA-DR 结合量进行动态的定量分析。结果严重烧伤患者伤后第1天开始 CD14^+单核细胞表面 HLA-DR 结合量明显低于正常对照组(P<0.05),其表达均值与烧伤面积呈显著负相关(r=-0.7232,P<0.05)。并发多脏器功能障碍综合征(MODS)者其 CD14^+单核细胞表面的 HLA-DR 表达量持续下降,其巾伤后第3、14、21、28天显著低于非 MODS 组(P<0.05)。随着 CD14^+单核细胞 HLA-DR 表达水平的下降,MODS 发生频率增加,患者预后不良。结论大面积烧伤可导致机体 CD14^+单核细胞 HLA-DR 表达严重受损和免疫功能障碍,动态观察其表达水平有助于烧伤后 MODS 的病程监测及患者预后判断。Objective To investigate the clinical significance of kinetic changes in quantitative expression of human leukocyte antigen DR （HLA-DR） in severely burned patients. Methods The blood samples of 77 extensively burned patients （ 〉 30% of total body surface area） were serially collected in the present study. The expression of HLA-DR on CD14^＋ mononuclear cell surface in burned patients were quantified by flow cytometry （using monoclonal antibody, QuantiBRITETM Anti-HLA-DR PE^＊/Anti- Monocyte PerCP-CyS. 5） on days 1, 3, 5, 7, 14, 21 and 28 post burn. Results The expressions of HLA- DR on CD14^＋ mononuclear cell surface in severely burned patients were significantly lower than those in healthy volunteers from the first day post burn （ P 〈 0. 05 ）, and the value of HLA-DR expression was negatively correlated with the burned area （ r = - 0. 7232, P 〈 0. 05 ）. The expression of HLA-DR in patients complicated with multiple organ dysfunction syndrome （MODS） was persistently decreased following major burns, and it was significantly lower than that of non-MODS patients on days 3, 14, 21 and 28 post burn （P 〈 0. 05 ）. The incidence rate of MODS rose markedly along with the lowering of HLA-DR expression, accompanied with poorer prognosis. Conclusions Extensive burns could result in marked damage in expression of HLA-DR on CD14^＋ mononuclear cell surface and immunologic dysfunction. Quantitative measurement of HLA-DR expression might be of significance in forecasting the development of MODS and prognosis in extensively burned patients.

关 键 词：烧伤 HLA抗原 多器官功能衰竭 预后 

分 类 号：R644[医药卫生—外科学]