重症脓毒症患者外周血单核细胞mCD14和HLA-DR的表达及临床意义  

The expression and clinical significance of mCD14,HLA-DR in peripheral blood mononuclear cell in patients with severe sepsis

作　　者：郭皓[1] 齐宇明[2] 王海燕[1] 胡振杰[3] 

机构地区：[1]河北省邯郸市中心医院ICU,056001 [2]河北省邯郸市中心医院妇产科,056001 [3]河北医科大学第四医院ICU

出　　处：《河北医药》2010年第22期3118-3120,共3页Hebei Medical Journal

摘　　要：目的观察重症脓毒症患者外周血单核细胞(PBMC)脂多糖受体(mCD14)、HLA-DR的表达变化及临床意义。方法选取符合重症脓毒症患者35例和健康志愿者15例作为对照。按预后分为生存组(25例)和死亡组(10例),用流式细胞仪检测PBMC表面mCD14、HLA-DR在病后不同时间的动态改变。结果死亡组PBMC表面mCD14、HLA-DR各点均显著低于正常对照组(P<0.01),生存组mCD14在0～24h明显低于正常对照组(P<0.01),48、72h恢复正常对照组水平;HLA-DR在0～48h均低于正常对照组,72h逐渐升高但仍未恢复正常对照水平,0～24h生存组与死亡组mCD14表达水平差异无统计学意义(P>0.05),第48、72小时生存组明显高于死亡组(P<0.05或<0.01);0～48h生存组与死亡组HLA-DR表达水平差异无统计学意义(P>0.05),第72小时生存组明显高于死亡组(P<0.05)。结论重症脓毒症患者单核细胞呈抑制状态,不同预后患者其免疫功能恢复时mCD14恢复早于HLA-DR。Objective To observe the change of expresion of mCD14, HLA-DR in peripheral blood mononuclear cell （PBMC） in patients with severe sepsis and its clinical meaning. Methods Thirty-five patients with severe sepsis and fifteen healthy volunteers were enrolled in this investigation. The thirty-five patient were divided into survival group （ n = 25 ） and nonsurvival group （ n = 10） , and fifteen healthy volunteers were served as control group. The expression of mCD14 in PBMC was detected by flow cytometry. Results The expression of mCD14, HLA-DR in PBMC in nonsurvival group was significantly lower than that in control group at every spot（ P 〈 0.01 ）, however, the expression of mCD 14 in survival group was significantly lower than that of control group at Oh, 12h,24h,while it returned to the normal range at 48h,72h. The expression of HLA-DR in nonsurvival group was significantly lower than that of control group at Oh, 12h ,24h ,48h, however, it returned to the normal range at 72h. There were no significant differences in the expression of mCD14 at Oh, 12h,24h between nonsurvival group and survival group （ P 〉 0.05 ） , but in survival group it was significantly higher than that in nonsurvival group at 48h,72 h（ P 〈0.05 and P 〈0.01 ）. There were no significant differences in the expression of HLA-DR at Oh, 12h,24h,48h between nonsurvival group and survival group, however, in survival group it was significandy higher than that in nonsurvival group at 72h （ P 〈 0.05 ）. Conclusion The peripheral blood mononuclear cells show a suppressive state in patients with severe sepsis, and the recovery of mCD14 is earlier than that of HLA-Dr in patients with different prognoses during their immune function recovery.

关 键 词：MCD14 HLA-DR 重症脓毒症 外周血单核细胞 

分 类 号：R631[医药卫生—外科学]