性激素对严重腹腔感染患者人白细胞-DR抗原和可溶性髓系细胞触发受体-1以及预后的影响  

The influence of sex hormones on human leukocyte antigen-DR, soluble myeloid cell receptor-1 and prognosis in patients with severe intra-abdominal infection

作　　者：傅强[1] 杜超[1] 巩传勇[1] 王娜[1] 

机构地区：[1]天津医科大学天津市南开医院外科重症监护病房,300100

出　　处：《中国危重病急救医学》2012年第8期461-464,共4页Chinese Critical Care Medicine

基　　金：国家重点基础研究发展计划（973）项目（2009CB522700）

摘　　要：目的评估血清雌二醇、泌乳素及睾酮等性激素水平对严重腹腔感染患者人白细胞DR抗原（HLA—DR）、可溶性髓系细胞触发受体-1（sTREM-1）以及预后的影响，进而评价性激素的临床应用价值。方法选择2009年7月10日至2010年2月9日天津市南开医院外科重症监护病房（ICU）收治的73例严重腹腔感染患者，入院72h内测定血清雌二醇、泌乳素以及睾酮水平（放射免疫法）；根据各指标水平分为雌二醇升高组（38例）和未升高组（35例）、泌乳素升高组（28例）和未升高组（45例）、睾酮降低组（33例）和未降低组（40例），记录各组患者入组时HLA—DR（流式细胞术）、sTREM-1（酶联免疫吸附试验）、急性生理学与慢性健康状况评分系统Ⅱ（APACHE11）评分，以及住院时间、住ICU时间、住院费用和28d病死率。结果与雌二醇未升高组相比，雌二醇升高组患者HLA—DR显著降低[（61．22±22．39）％比（75．09±14．85）％]，sTREM-1（ng／L）显著增高（291．59±148．13比216．484-124．82），APACHEⅡ评分（分）明显下降（11．47±6．88比15．36±8．79），住院费用（万元）明显增加（10．98±8．15比6．25±3．51），住ICU时间（d）明显缩短（8．56±4．05比12．17±7．99），28d病死率明显下降（10．00％比32．75％，P〈0．05或P〈0．01）；与泌乳素未升高组相比，泌乳素升高组患者HIA—DR明显降低[（61．19±21．50）％比（72．02±18．49）％]，sTREM-1显著增高（307．92±173．93比223．01±106．93），住院费用明显减少（7．75±3．52比11．36±8．24），住ICU时间显著缩短（9．14±3．15比13．24±2．16，均P〈0．05）；与睾酮未降低组相比，睾酮降低组患者HIA—DR显著升高[（74．69±14．72）％比（62．24±22．54）％]，sTREM-1明显降低（208．77±77．80比294．20±169．36），APACHEⅡ评分明显下降（10．57±6．97比15．39±9．46�Objective To evaluate the influence of serum estradiol, prolactin and testosterone levels on human leukocyte antigen-DR （HLA-DR）, soluble myeloid cell receptor-1 （sTREM-1） and prognosis in patients with severe abdominal infection, in order to evaluate the clinical value of the above-mentioned sex hormones. Methods From July 10, 2009 to February 9, 2010, 73 cases with severe intra-abdominal infections hospitalized in surgical intensive care unit （ICU） of Tianjin Nankai Hospital were enrolled. Within 72 hours after enrollment, serum estradiol, prolactin and testosterone levels were detected by radioimmunoassay. Based on their levels, all the cases were divided into increased estradiol group （ n=38 ） and non-increased estradiol group （ n = 35 ）, increased prolaetin group （ n =28 ） and non-increased prolactin group （n=45）, decreased testosterone group （n=33 ） and non-decreased testosterone group （n =40） respectively. In addition, HLA-DR （flow cytometry）, as well as of sTREM-1 （enzyme linked immunosorbent assay）, acute physiology and chronic health evaluation II （APACHE II ） score, hospital days, the ICU length, hospital costs and 28 day mortality were recorded. Results Compared with non-increased estradiol group, HLA-DR in increased estradiol group decreased significantly [（61.22 ± 22.39）% vs. （75.09 ± 14.85）% ], while sTREM-1 （ng/L） increased obviously （291.59 ± 148.13 vs. 216.48 ± 124.82）, APACHE II score lowered dramatically （ 11.47 ± 6.88 vs. 15.36 ± 8.79）, hospital costs （ten thousands） raised significantly （ 10.98 ± 8.15 vs 6.25 ± 3.51 ）, ICU length （days） was much shorter （8.56 ± 4.05 vs. 12.17 ± 7.99）, and 28 days mortality was significantly lowered （10.00% vs. 32.75%, P〈0.05 or P±0.01 ）. Compared with non-increased prolactin group, increased prolactin group had much lower HLA-DR levels ±.（61.19 ± 21.50）% vs. （72.02 ± 18.49）% 1, higher sTREM-1 levels （307.92 ± 173.93 vs. 223.01 ± 106.93）, at t

关 键 词：雌二醇 泌乳素 睾酮 人白细胞DR抗原 可溶性髓系细胞触发受体-1 感染 预后 

分 类 号：R446.1[医药卫生—诊断学]