肝移植术后外周血单核细胞活化率变化及影响因素分析  

Analysis of changes and influencing factors of activation rate of peripheral blood monocytes after liver transplantation

作　　者：宫钰 吴蕙 朱捷 王婷 黄晓武[3] GONG Yu;WU Hui;ZHU Jie;WANG Ting;HUANG Xiaowu(Department of Critical Care Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Clinical Laboratory,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Liver Surgery and Transplantation,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院重症医学科,上海200032 [2]复旦大学附属中山医院检验科,上海200032 [3]复旦大学附属中山医院肝胆肿瘤与肝移植外科,上海200032

出　　处：《中国临床医学》2025年第1期101-107,共7页Chinese Journal of Clinical Medicine

基　　金：复旦大学附属中山医院基金(2021ZSQN73).

摘　　要：目的分析肝移植术后外周血单核细胞活化率对病情恢复的影响,并初步探讨单核细胞活化率变化的影响因素。方法选择2020年9月至2023年6月在复旦大学附属中山医院肝胆肿瘤与肝移植外科接受同种异体原位肝移植手术的患者139例。将外周血中CD14^(+)HLA-DR^(+)的单核细胞比例定义为单核细胞活化率,计算术后第7天(postoperative day 7,POD7)和术后第1天(postoperative day 1,POD1)的单核细胞活化率差值(Δ)。将患者分为Δ>0组(n=73)和Δ<0组(n=66),比较两组患者的血常规、肝肾功能、凝血指标、感染指标、ICU住院天数、总住院天数和90 d死亡率。采用流式细胞技术检测肝移植POD1和POD7外周血中单核细胞不同亚群(Mo0、Mo1、Mo2和Mo3)的比例变化和HLA-DR表达量。结果Δ<0组患者的ICU住院天数显著长于Δ>0组患者[18(12,26)d vs 14(10,20.5)d,P=0.018]。肝移植POD1时,Δ>0组患者Mo0的比例显著低于Δ<0组患者(P<0.05);POD7时,Δ>0组患者Mo0的比例显著低于Δ<0组患者(P<0.001),而Mo1、Mo2和Mo3的比例显著高于Δ<0组患者(P<0.001)。与POD1相比,肝移植患者POD7外周血Mo0的HLA-DR表达量明显下降(P<0.01);而Mo1、Mo2和Mo3的HLADR表达量差异无统计学意义。结论外周血中单核细胞亚群Mo0(CD14^(low)CD16^(-)HLA-DR^(low))的比例增加可能是肝移植患者单核细胞活化率出现差异的影响因素,单核细胞活化率差值或许可以作为评估肝移植患者免疫状态变化和术后恢复的临床新指标。Objective To analyze the effect of the activation rate of peripheral blood monocytes on the recovery of patients after liver transplantation and to initially explore the possible influencing factors for differences in monocyte activation rates.Methods A total of 139 patients who underwent orthotopic liver transplantation from September 2020 to June 2023 at Department of Liver Surgery and Transplantation of Zhongshan Hospital,Fudan University were selected.The proportion of CD14^(+)HLA-DR^(+)monocytes in peripheral blood was defined as the monocyte activation rate.The difference in monocyte activation rates between postoperative day 7(POD7)and postoperative day 1(POD1)was calculated asΔ,and patients were divided intoΔ>0 group(n=73)andΔ<0 group(n=66).The two groups were compared in terms of complete blood count,liver and kidney function,coagulation indicators,infection indicators,ICU length of stay,total length of hospitalization,and 90-day mortality.Changes in the proportions of different monocytes subsets(Mo0,Mo1,Mo2,and Mo3)and HLA-DR expression in peripheral blood on POD1 and POD7 were detected using flow cytometry.Results The ICU length of stay in theΔ<0 group was significantly longer than that in theΔ>0 group(18[12,26]days vs 14[10,20.5]days,P=0.018).On POD1,the proportion of Mo0 in theΔ>0 group was significantly lower than that in theΔ<0 group(P<0.05);on POD7,the proportion of Mo0 in theΔ>0 group was significantly lower than that in theΔ<0 group(P<0.001),while the proportions of Mo1,Mo2,and Mo3 were significantly higher than those in theΔ<0 group(P<0.001).Compared to POD1,the HLA-DR expression level of Mo0 in peripheral blood of patients with liver transplantation significantly decreased on POD7(P<0.01),while there was no significant difference in HLA-DR expression levels of Mo1,Mo2,and Mo3.Conclusions Increased proportion of Mo0(CD14^(low)CD16^(−)HLA-DR^(low))among peripheral blood monocyte subsets may be one of the influencing factors for the differences in monocyte activation rates in patients

关 键 词：肝移植 单核细胞 免疫状态 临床转归 

分 类 号：R617[医药卫生—外科学]