创伤后肠屏障功能障碍与免疫失调的相关性研究  

The study of correlation between immune dissonance and intestinal barrier dysfunction induced by trauma

作　　者：王印华[1] 王宝华[1] 唐明贵[1] 白静[1] 浦践一[1] 

机构地区：[1]河北联合大学附属医院ICU,河北唐山063000

出　　处：《肠外与肠内营养》2014年第3期129-131,共3页Parenteral & Enteral Nutrition

基　　金：河北省科技计划项目(12276104D-6)

摘　　要：目的:探讨创伤后肠屏障功能障碍与免疫失调的相关性,为保护肠屏障功能、改善多器官功能障碍综合征(MODS)的临床预后提供免疫支持的依据。方法:选择70例创伤后并发多器官功能障碍的病人,监测第1、3、7天外周血二胺氧化酶(DAO)、CD14+单核细胞的人类白细胞抗原DR等位基因(HLA-DR)的表达率,记录病人同期Marshall评分和4周时的预后情况。结果:按Marshall分值高低分组,评分高的病人,血DAO含量相应较高(P<0.01)。经过治疗,每个评分组血DAO含量均呈逐渐下降趋势(P<0.05)。4周内死亡26例,存活44例。在所观察时段中,死亡组单核细胞HLA-DR表达率均明显低于存活组(P<0.01),且持续处于水平低的状态;血DAO含量和Marshall评分均明显高于存活组(P<0.01)。存活组血DAO含量和Marshall评分逐渐降低、单核细胞HLA-DR表达率逐渐升高(P<0.05)。血DAO与单核细胞HLA-DR表达率呈负相关(P<0.01)。结论:肠屏障功能受损明显的病人,免疫抑制亦明显,器官功能受损更严重。单核细胞HLA-DR表达率对评估创伤后肠屏障功能障碍病人的预后具有良好的应用价值。Objective：To explore the correlation of immune dissonance and intestinal barrier dysfunction induced by emergency trauma.Methods：Seventy patients after trauma were included.DAO and CD14 ＋ monocyte HLA-DR expression level in peripheral blood were detected on the 1st,3rd and 7th day,and Marshall score and prognosis on 28th day were evaluated.Results：All patients were sectionalized in accordance with Marshall scores,and the high-score ones accordingly had high-priced DAO （P 〈 0.01）.In every group DAO was lowered gradually during the observation period（P 〈 0.05）.26 cases died and 44 cases survived within 4weeks.In died cases,low level of HLA-DR was persistently detected,and higher DAO and Marshall score were found （P 〈0.01）.In the surviving cases,the DAO and Marshall score were gradually decreased and HLA-DR were significantly increased （P 〈 0.05）.The level of DAO had an inverse correlation to HLA-DR （rs =-0.384,P 〈 0.01）.Conclusion：Patients with evident intestinal barrier dysfunction always gain immune suppression,together with severe organ damages.The level of DAO has an inverse correlation to HLA-DR,and HLA-DR is qualified to the valuation of evaluating prognosis for intestinal barrier dysfunction induced by trauma.

关 键 词：创伤 肠屏障功能障碍 免疫失调 CD14+单核细胞HLA-DR表达率 

分 类 号：R459.7[医药卫生—急诊医学]