单核细胞人类白细胞抗原DR预测重症多发伤感染的临床应用研究  

Clinical study on monocyte human leukocyte antigen-DR expression predicting multi-site infections in severe multiple trauma

作　　者：胡晓蕾[1] 尧银光[1] 武蓉珍[1] 刘素霞[1] 赵志钢[1] 

机构地区：[1]丽水市中心医院检验科,浙江丽水323000

出　　处：《中华医院感染学杂志》2016年第11期2456-2458,2493,共4页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科学研究基金资助项目(2014KYA278);浙江省丽水市科技计划基金资助项目(2012ZC029)

摘　　要：目的探讨连续监测单核细胞表面人类白细胞抗原DR(human leukocyte antigen-DR,HLA-DR)表达率变化在重症多发伤患者预后判断中的临床意义,为重症多发伤患者的感染预防治疗寻找参考指标。方法选择2013年2月-2015年2月医院ICU收治的54例重症多发伤患者为研究对象,用流式细胞术检测其入院时以及第2、4、6、8、10、15天外周血CD14阳性单核细胞表面HLA-DR表达率;根据患者28d内感染情况分为多部位感染组15例、非多部位感染组39例,分析HLA-DR表达率变化规律与多部位感染的关系。结果 54例重症多发伤患者中有15例发生多部位感染,感染率达27.8%;ROC曲线分析显示,第4、6、8天的HLA-DR表达率及其与入院时的HLA-DR表达率的差值预测重症多发伤患者多部位感染,差异有统计学意义(P<0.01),曲线下面积分别为0.804、0.913、0.953、0.768、0.875、0.934;HLA-DR8≤58%预测多部位感染的敏感性为93.3%、特异性为89.7%;HLA-DR6≤49%预测多部位感染的敏感性为80.0%、特异性为89.7%;△HLA-DR6-0≤-27%预测多部位感染的敏感性为80.0%,特异性为82.0%;△HLA-DR8-0≤-7%预测多部位感染的敏感性为97.4%、特异性为76.9%;各参数的阳性预测值低,阴性预测值高。结论外周血单核细胞表面HLA-DR表达率的连续监测在预测重症多发伤患者多部位感染,判断预后和预防治疗感染中具重要价值。OBJECTIVE To probe the clinical value of continuous monitoring changes of monocyte human leukocyte antigen-DR（HLA-DR）expression on prognosis in patients with severe multiple trauma and find reference for infection prevention.METHODS A total of 54 patients with severe multiple trauma hospitalized in Lishui Central Hospital Intense care unite from Feb.2013 to Feb.2015 were included in the study.The HLA-DR expression on CD14-positive monocyte in 54 severe multiple trauma patients＇ peripheral blood on day 1,day 3,day 5,day 7,day9,day 14 after admission were detected by cytometry.After a 28-day follow-up,54 patients were divided into two groups,which are multi-site infected group（15 cases）and non-multi-site infected group（39 cases）.The relationship between HLA-DR expression and multi-site infection were analyzed.RESULTS Totally 15 patients were multi-site infected with the rate of 27.8%.According to receiver operating curve analysis（ROC）curve,the HLA-DR expression on day 3,day 5,day 7and their difference from day 0were statistically valuable on predicting multi-site infection of severe multiple trauma with the area under curve（AUC）as 0.804,0.913,0.953,0.768,0.875,0.934 respectively.The sensitivity and specificity of HLA-DR7≤58%,HLA-DR5≤49%,△HLA-DR5-0≤-27%,△HLA-DR7-0≤-7% in predicting multi-site infection were 93.3% and 89.7%,80.0% and 89.7%,80.0% and 82.0%,97.4% and 76.9%respectively.And the positive predictive values were low while the negative predictive values were high.CONCLUSIONContinuous monitoring the changes of HLA-DR expression might be valuable on predicting the multi-site infection and the prognosis and infection prevention in severe multiple trauma.

关 键 词：重症多发伤 多部位感染 单核细胞 人类白细胞抗原-DR 

分 类 号：R641[医药卫生—外科学]