特重度烧伤患者细胞免疫功能障碍与预后的相关性研究  

The relationship between dysfunction of cell-mediated immunity and prognosis in severely burned patients

作　　者：董宁[1] 金伯泉[1] 姚咏明[2] 于燕[2] 盛志勇[2] 

机构地区：[1]第四军医大学免疫学教研室,陕西西安710032 [2]解放军总医院第一附属医院全军烧伤研究所,北京100037

出　　处：《中国危重病急救医学》2008年第9期516-519,共4页Chinese Critical Care Medicine

基　　金：国家重点基础研究发展规划项目（2005CB522602）;国家杰出青年科学基金项目（30125020）;首都医学发展基金重点项目（2003-2023）

摘　　要：目的探讨特重度烧伤患者细胞免疫功能指标变化与临床预后的关系及其意义。方法26例总体表面积≥70％的特重度烧伤患者按临床预后分为存活组（12例）和死亡组（14例）；11例同期献血者作为健康对照组。采集患者伤后1、3、7和14d外周静脉血，用流式细胞仪定量分析CD14^＋单核细胞表面人白细胞DR抗原（HLA—DR）表达量，用噻唑蓝（MTT）比色法测定外周血T淋巴细胞增殖反应活性，用酶联免疫吸附法（ELLSA）测定白细胞介素-2（IL-2）分泌水平。结果与存活组比较，死亡组在伤后14d T淋巴细胞增殖反应活性（0．739±0．299比0．320±0．237）和IL-2分泌水平[（11．02±2．50）ng／L比（8．21±2．63）ng／L3均显著下降（P〈0．01和P〈0．05）；伤后1～14d，死亡组CD14^＋单核细胞表面HLA—DR表达量持续下降，而存活组则有所回升，伤后14d时两组比较差异有统计学意义（P〈0．01）。结论特重度烧伤患者细胞免疫功能处于持续抑制状态，动态监测CD14^＋单核细胞表面HLA—DR表达量、T淋巴细胞增殖反应活性和IL-2分泌水平，对于判断患者预后可能有重要临床参考价值。Objective To investigate the relationship between dysfunction of cell-mediated immunity and prognosis in severely burned patients. Methods Twenty-six patients with total burn surface area larger than 70% total body surface area （TBSA） were included in the present study, and they were divided into non-survival group （14 cases） and survival group （12 cases）. Eleven healthy volunteers served as controls. The blood samples were collected on days 1, 3, 7, 14 postburn, the human leukocyte antigen-DR （HLA-DR） bound on CD14^＋ mononuclear cell surface of burned patients was quantified by flow cytometry （using monoclonal antibody, QuantiBRITETM anti-HLA-DR PE/anti-monocyte PerCP-CyS. 5）. The ability of T lymphocyte proliferation was determined by thiazolyl blue （MTT） method, and interleukin-2 （IL-2） release was measured by enzyme-linked immunosorbent assay （ELISA）. Results Compared to the survival group, the T lymphocyte proliferative activity （0. 739±0. 299 vs. 0. 320±0. 237） and IL-2 release [（11.02± 2.50） ng/L vs. （8. 21±2.63） ng/L] in non-survival group were significantly decreased on postburn day 14 （P〈0.01 and P〈0.05）. The expression of HLA-DR on CD14^＋ mononuclear cell surface was persistently decreased in non-survivors, while it markedly elevated in survivors after 14 days postburn （P〈0.01）. Conclusion The cellular immune function is consistently suppresed in severely burned patients. Sequential monitoring of T lymphocyte proliferation, IL-2 release, and the amount of HLA-DR on CD14^＋ mononuclear cell surface might be of clinical prognostic significance in patients with massive burn injury.

关 键 词：烧伤 人白细胞DR抗原 T淋巴细胞 免疫功能 预后 

分 类 号：R686[医药卫生—骨科学]