CD14阳性单核细胞HLA—DR表达率对严重创伤患者预后的判断意义  

The application of the HLA - DR expression on CD14 positive monocytes to the prognosis in major trauma patients

作　　者：陈怿[1] 林幼萍[1] 江东新[1] 苏磊[2] 

机构地区：[1]暨南大学附属东莞医院东莞市第五人民医院,广东东莞523900 [2]广州军区广州总医院重症医学科解放军热区损伤及组织修复重点实验室,广东广州510010

出　　处：《中国急救医学》2015年第9期844-848,共5页Chinese Journal of Critical Care Medicine

基　　金：军队“十二五”重点科研基金课题资助项目（PLABWS12J108）;东莞市医疗卫生科技计划项目（201510105101088）

摘　　要：目的观察严重创伤患者早期CDl4阳性单核细胞HLA—DR表达率（HLA—DRCDl4＋％）的变化规律，并探讨HLA—DRCD14＋％与严重创伤的预后关系及意义。方法回顾性分析2010—06～2012—12在广州军区广州总医院急危重症救治中心住院的严重创伤患者（AIS—ISS评分≥16分）共79例，生存组（n=54）和死亡组（n=25），分析两组患者伤后年龄、性别构成、AIS—ISS评分、APACHEII评分、GCS评分、致伤因素、受伤部位、血清降钙素原（PCT）和HLA—DRCDl4＋％、接受损伤控制性手术例数和免疫调理等方面的差别，观察并分析患者伤后第3、7天的APACHEII评分和HLA—DRCDl4＋％的变化以及二者的相关性，采用ROC曲线及回归分析评估HLA—DRCDl4＋％对严重创伤患者死亡的预判价值。结果两组患者入院情况分析比较差异无统计学意义（P〉0．05），所有患者APACHEII和HLA—DRCDl4’％变化具有统计学意义（P〈0．05）。与对照组比较，死亡组HLA—DRCDl4＋％在第3天开始出现下降（P〈0．05），而死亡组APACHEII在第7天才高于存活组（P〈0．05）。以第3天HLA—DRCDl4＋％值对于严重创伤患者死亡预判差异有统计学意义（P〈0．05），其ROC曲线下总面积为0．894。多因素回归分析严重创伤患者第3天HLA—DRCDl4＋％值是预判死亡的危险因素。结论HLA—DRCDl4＋％是预判严重创伤患者预后的可靠指标，受伤后第3天HLA—DRCDl4＋％水平是预测严重创伤患者死亡的危险因素。Objective To investigate the variation of HLA - DR expression on CD14 positive monocytes （ HLA - DR CD14＋ % ） and the importance of HLA - DR CD14 ＋ % using for the prognosis of patients with major trauma. Methods Seventy - nine patients with major trauma who admitted in the emergency and critical care center in General Hospital of Guangzhou Military Command from Jun, 2010 to Dec, 2012 were divided into survivor group （n = 54） and non - survivor group （n = 25 ）. The differences between two groups on age, gender, AIS - ISS scores, APACHE ]I scores, GCS scores, wound agent, injury portion, the members accepted emergency operation and immunotherapy, the level of procalcitonin （PCT） and HLA - DR CD14 ＋ % were analyzed. The pattern of APACHE Ⅱ and HLA - DR CD14＋ % level were observed from 3rd to 7th day following the injury. ROC program and regression analysis were performed to evaluate the value of HLA - DR CD14 ＋ % for the prognosis of patients with major trauma. Results There was no difference on the baseline between two groups （ P 〉 0.05 ）. A significant correlation was found between APACHE Ⅱ and HLA - DR CD14 ＋ % level in these patients after the injury （P 〈0.05）. However, the level of HLA -DR CD14~ % on 3rd day in non- survivor group was observed to decrease in comparison with the level in survivor group. And the value of APACHE Ⅱ in non - survivor group presented to increase in comparison with the value in survivor group until 7th days. On 3rd day, the level of HLA - DR CD14＋ % was statistically valuable to the outcome. The AUC in ROC program for predictive value of HLA - DR CD14 ＋% on 3rd day was 0. 894. Moreover, the lower level of HLA - DR CD14 ＋ % on 3rd day was a hazard risk for death by multivariate regression analysis. Conclusion The level of HLA - DR CD14 ＋% was reliably applied to the prognosis of the patients with major trauma. On 3rd day after injury, the lower value of HLA - DR CD14 ＋ % was a hazard risk for death

关 键 词：严重创伤 预后 CD14阳性单核细胞HLA-DR表达率 急性生理与慢性健康状况评分Ⅱ(APACHE Ⅱ) 免疫功能 

分 类 号：R378[医药卫生—病原生物学]