CD14^＋／人白细胞DR抗原测定在原位肝移植术后患者感染监测中的作用  

Role of assessment and monitoring of human leucocyte antigen-DR on CD14^ monocyte in postoperative infection in patients after orthotopic liver transplantation

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

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

出　　处：《中国危重病急救医学》2010年第1期20-23,共4页Chinese Critical Care Medicine

基　　金：广东省自然科学基金资助项目（05000139）

摘　　要：目的探讨原位肝移植术后CD14^＋单核细胞人白细胞DR抗原（CD14^＋／HLA—DR）表达率的变化及其在术后感染监测中的作用。方法按照美国胸科医师协会／危重病医学会（AccP／sCcM）的感染性休克定义，将63例肝移植术后患者分为非感染组（47例）、感染组（10例）、感染性休克组（6例）；用流式细胞仪动态监测患者移植前后CD14^＋／HLA—DR表达率，并进行受试者工作特征曲线（ROC曲线）分析，评价其在感染监测中的价值。结果感染组和感染性休克组术后CD14^＋／HLA—DR表达率均显著低于非感染组[感染组：（29．6±7．2）％，感染性休克组：（16．3±10．5）％比（62．3±18．3）％，均P〈0．01]，但两组间差异无统计学意义（P=0．128）。CD14^＋／HLA—DR表达率对感染预测的R0c曲线下面积为0．965，在最佳截断点（cutoff）值为36．35％时敏感性和特异性分别为100．0％和93．6％；CD14^＋／HLA—DR表达率对感染性休克预测的ROC曲线下面积为0．968，在最佳截断点值为31．97％时敏感性和特异性分别为100．00和87．7％。3组患者移植前后不同时间点比较发现，感染发生时，感染组、感染性休克组CD14^＋／HLA—DR表达率较非感染组移植后显著下降（P〈0．05和P〈0．01），在感染最重时两组CD14^＋／HLA—DR表达率均降到最低值[感染组：（29．6±7．2）％，感染性休克组：（16．3±0．5）％，均P〈0．013。结论对高危或可疑感染的肝移植术后患者，动态监测CD14^＋／HLA—DR表达率可作为病情判断及预后的良好指标，CD14^＋／HLA—DR≤36．35％可作为肝移植术后发生感染的预警值；CD14^＋／HLA—DR≤31．970可作为判断合并感染性休克的警戒指标。Objective To investigate the changes in expression level of human leucocyte antigen-DR （HLA-DR） on CD14^ monocyte （CD14^/HLA-DR） in the patients after orthotopic liver transplantation, and its role in monitoring postoperative infection. Methods Sixty-three patients with liver transplantation were divided into three groups, non-infection group with 47 cases, infection group with 10 cases and septic shock group with 6 cases [according to the definition of septic shock of American College of Chest Physicians/Society for Critical Care Medicine （ACCP/SCCM）]. CD14^/HLA-DR expression ratio was assessed with flow cytometer, and its clinical implication was evaluated by receiver operating characteristic （ROC） curve assay. Results CD14^/HLA-DR expression ratio in infection group [（29.6±7.2）%]nd septic shock group [（16.3±10.5）%]ere significantly lower than that in non-infection group [（62.3±18.3）%, both P〈 0. 013, but no significant difference of CD14^/HLA-DR expression ratio was found between infection group and septic shock group （P 〈 0. 128）. Total area under ROC curve of CD14^/HLA-DR expression ratio for the infection was 0. 965, its sensitivity and specificity at 36.35% cut off were 100. 0% and 93.6%, respectively. Total area under ROC curve of CD14^/HLA-DR expression ratio to predict septic shock was 0. 968, its sensitivity and specificity at 31.97% cut off were 100. 0% and 87. 7%, respectively. Comparing the change of CD14^/HLA-DR expression, it was lower in the infection group and septic shock group （P〈. 05 and P^0. 01）, and the expression rate was lowest during period of serious infection in the two groups [infection group：（29.6±7.2）%, septic shock group：（16.3±0.5）%, all P〈0.01]; Conclusion For the patients with possible infection after liver transplantation, sequential assessment of CD14^/HLA-DR expression ratio would be a good marker for the judgment of patientrs conditions and outcome. CD14^/HLA-DR expression ratio below 36.35% could be used as the

关 键 词：肝移植 CD14^+ 单核细胞人白细胞DR抗原 术后感染 感染性休克 

分 类 号：R657.3[医药卫生—外科学]