肝移植术后CD14^+单核细胞人白细胞DR抗原表达率的变化及其意义  

Implication of expression rate of HLA-DR antigen on CD14^+ monocyte in patients after liver transplantation

作　　者：文强[1] 苏磊[1] 刘志锋[1] 邱俊铭[1] 郭振辉[2] 霍枫[3] 

机构地区：[1]广州军区广州总医院ICU科,510010 [2]广州军区广州总医院MICU科,510010 [3]广州军区广州总医院肝胆外科,510010

出　　处：《实用医学杂志》2009年第14期2251-2253,共3页The Journal of Practical Medicine

基　　金：广东省自然科学基金资助项目(编号:05000139)

摘　　要：目的:探讨肝移植术后CD14+单核细胞人白细胞DR抗原(HLA-DR)表达率的变化及其在感染监测和判断临床预后方面的作用。方法:65例肝移植术后患者分为非感染组、感染组,用流式细胞仪检测其CD14+单核细胞HLA-DR水平,比较两组间CD14+单核细胞HLA-DR表达率的差别。同时按CD14+单核细胞HLA-DR表达率分布将患者分为HLA-DR≥40%(A组)、21%～39%(B组)、HLA-DR≤20%(C组),比较3组间临床预后的差别。结果:感染组CD14+单核细胞HLA-DR表达率为(25.6±9.2)%,比非感染组的(61.3±18.2)%明显减少(P<0.05)。B、C两组在ICU停留时间、术后至出院时间与A组比较明显延长(P<0.05),以C组延长更为显著(P<0.01),B、C两组比较差异则无显著性。A、B、C3组在感染率和病死率之间比较差异亦有显著性(P<0.05)。结论:CD14+单核细胞HLA-DR表达率是监测肝移植术后感染及判断临床预后的良好指标,特别是针对高危或可疑感染的术后患者,动态的CD14+单核细胞HLA-DR监测对病情判断和治疗调整均有指导意义。Objective To investigate the role of the expression rate of HLA-DR antigen on CD14^＋ monocyte （CD14^＋/HLA-DR） in the infection monitoring and clinical prognosis in patients after liver transplantation. Methods 65 patients after liver transplantation were firstly divided into 2 groups ： non-infection group and infection group. According to the expression rate of CD14^＋/HLA-DR, which were detected by flow eytometry, these patients were further divided into 3 groups： HLA-DR≥ 40% （group A）, 20% 〈 HLA-DR 〈 40% （group B）, and HLA-DR≤ 20% （group C）, and their clinical prognosis were compared. Results The expression rate of CD14^＋/HLA-DR in infection group was significantly lower than that in non-infection group [ （25.6 ± 9.2）% vs （61.3± 18.2）, P 〈 0.05]. Time in ICU and in hospitalization in groups B and C were significantly longer than that in group A （P 〈 0.05, P 〈 0.01 ）, but no significant differences were found between group B and group C. Moreover, there were significant differences in infection rate and mortality among the three groups （P 〈 0.05）. Conclusions CD14^＋/HLA-DR expression rate is a good marker to monitor the postoperative infection and to predict the outcome of patients after liver transplantation.

关 键 词：肝移植 HLA-DR抗原 单核细胞 抗原 CD14+ 临床预后 

分 类 号：R657.3[医药卫生—外科学]