老年脓毒症患者活化淋巴细胞的表达及意义  

Lymphocyte histocompatibility leukocyte antigen DR expression in elderly sepsis patients

作　　者：周筱琼[1] 严静[2] 于小妹[1] 王强[1] 叶雄伟[1] 

机构地区：[1]浙江医院检验科,杭州310013 [2]浙江医院重症监护室,杭州310013

出　　处：《中国卫生检验杂志》2010年第12期3090-3093,共4页Chinese Journal of Health Laboratory Technology

基　　金：卫生部科学研究基金-浙江省医药卫生重大科技计划2005年度立项课题(WKJ2005-2-035)

摘　　要：目的:评价活化淋巴细胞,CD14+单核细胞人白细胞DR抗原(HLA-DR)在老年脓毒症患者中的表达及预后判断的临床价值。方法:194例脓毒症患者(试验组),根据脓毒症组预后分存活组和死亡组,143例有相同基础疾病但无脓毒症患者(对照组),分别采用流式细胞仪检测其活化淋巴细胞HLA-DR水平、CD14+单核细胞HLA-DR及T淋巴细胞亚群及B淋巴细胞、NK淋巴细胞百分比,将这些免疫指标进行统计分析。结果:CD3+HLA-DR+、CD8+HLA-DR+、CD4+HLA-DR+水平脓毒症患者均显著高于非脓毒症患者,差异有统计学意义(P<0.05)。其中CD3+HLA-DR+脓毒症组(25.42±15.52)%>对照组(17.95±10.31)%。CD8+HLA-DR+脓毒症组(32.85±21.69)%>对照组(24.07±15.11)%。CD4+HLA-DR+脓毒症组(16.29±10.90)%>对照组(13.72±7.51)%。CD14+单核细胞HLA-DR水平脓毒症患者显著低于非脓毒症患者,差异有统计学意义(P<0.01),脓毒症组(46.54±27.07)%<对照组(76.69±17.02)%。脓毒症组CD19+、CD3+CD8+水平显著高于对照组,CD3+CD4+、CD16+56+水平则显著低于对照组,差异有统计学意义(P<0.05)。死亡组较存活组:CD3+HLA-DR+、CD8+HLA-DR+水平显著升高(P<0.05),CD14+HLA-DR+水平显著下降(P<0.01)。结论:老年脓毒症患者外周血活化淋巴细胞HLA-DR水平显著升高,单核细胞HLA-DR水平显著降低,且与预后相关,表明脓毒症患者免疫系统同时存在免疫抑制与免疫激活两种状态。Objective：To investigate the clinical value of CD14＋ monocyte and lymphocyte histocompatibility leukocyte antigen DR（HLA-DR） expression in elderly sepsis patients.Methods： A total of 337 elderly patients were divided into 2 groups,194 namely the sepsis group and 143 non-sepsis but the same basis disease group.194 sepsis patients were divided into survival group and death group according to prognosis.CD14＋ monocyte and lymphocyte HLA-DR expression and lymphocytes subpopulation from each subject were determined by flow cytometry.The HLA-DR levels were compared between the groups.Results：The levels of lymphocyte HLA-DR（CD3＋ /HLA-DR＋,CD4＋ /HLA-DR＋,CD8＋ /HLA-DR＋） expression were significantly increased in sepsis group than non-sepsis group（P0.05）.CD3＋HLA-DR＋ increasing in sepsis group 25.42±15.52% non-sepsis group 17.95±10.31%.CD8＋HLA-DR＋ increasing in sepsis group 32.85±21.69% non-sepsis group 24.07±15.11%.CD4＋HLA-DR＋ increasing in sepsis group 16.29±10.90% non-sepsis group 13.72±7.51%.CD14＋ /HLA-DR expression was significantly lower in sepsis group than non-sepsis group（P0.01）,discreasing in sepsis group 46.54±27.07% non-sepsis group 76.69±17.02%.CD14＋ /HLA-DR＋ expression in death group was significantly lower than in survival group（P0.01）.Conclusion：Both immune suppression and immune activation were primarily found in patients with sepsis.CD3＋ /HLA-DR＋,CD4＋ /HLA-DR＋,CD8＋ /HLA-DR＋,CD14＋ /HLA-DR＋ were valuable in predicting the prognosis of patients with sepsis.

关 键 词：老年 脓毒症 活化淋巴细胞 人白细胞DR抗原 CD14+单核细胞 

分 类 号：R631[医药卫生—外科学]