CD_(14)^+单核细胞人类白细胞抗原-DR预测脓毒症预后及指导免疫调理治疗的初步临床研究  

Clinical trial to verify the value of the CD_(14)^+ monocyte human leukocyte antigen DR as a marker in evaluating immunosuppression in patients with severe sepsis

作　　者：林洪远[1] 郭旭生[1] 姚咏明[1] 程尉新[1] 翁志华[1] 韦文韬[1] 盛志勇[1] 

机构地区：[1]解放军第三○四医院,北京100037

出　　处：《中国危重病急救医学》2003年第3期135-138,共4页Chinese Critical Care Medicine

基　　金：全军"十五"指令性课题资助 ( 0 1L 0 80 )

摘　　要：目的 :验证 CD+ 1 4 单核细胞人类白细胞抗原 DR( HL A DR)对于评估严重脓毒症患者免疫功能的作用 ;探讨胸腺 5肽 ( TP 5 )治疗免疫抑制的有效性。方法 :符合严重脓毒症标准 ,CD+ 1 4 单核细胞 HL A DR<30 %的患者被定义为脓毒症免疫抑制和代偿性抗炎症反应综合征 ( CARS)者纳入本研究 ,并接受 1m g TP 5肌肉注射 ,1次 / d,直至 CD+ 1 4 单核细胞 HL A DR>5 0 %或死亡。在 TP 5治疗前及结束治疗时分别测量 CD+ 1 4单核细胞 HL A DR和肿瘤坏死因子α( TNFα)、白介素 6 ( IL 6 )、IL 10和 IL 13。结果 :15例患者存活 ,5例死亡。经 TP 5治疗后所有患者的 CD+ 1 4 单核细胞 HL A DR均有不同程度提高 ,但仅存活者有显著差异。所有患者细胞因子均高于健康对照 ,治疗后存活患者的 TNFα、IL 6明显下降 ;死亡者各种细胞因子变化不明显。结论 :用 CD+ 1 4 单核细胞 HL A DR鉴别脓毒症免疫抑制并指导免疫刺激治疗是安全可靠的 ,且对评估预后有重要价值 ;TP 5可能对逆转免疫抑制有效 ,但需要严格的对照治疗研究确认 ;脓毒症的免疫抑制发生和逆转与促炎 /抗炎细胞因子平衡无关 ,确切机制有待深入探讨。Objective:To verify that CD+ 14 monocyte human leukocyte antigen DR(HLADR) may serve as a reliable index for immunosupression,and for prediction of prognosis as well as to evaluate the efficacy of Thymopentin (TP5) to enhance immunologic function in patients with severe sepsis,and to evaluate the validity of compensatory antiinflammatory response syndrome(CARS).Methods: Patients in a SICU with symptoms and signs of severe sepsis conforming to the criteria set forth by ACCP/SCCM were enrolled in this clinical trial.CD+ 14 monocyte HLADR was determined by flow cytometry.To those with HLADR<30%,TP5,1 mg,q.d. was administered till HLADR raised or death occurred. Before the treatment was begun and ended,CD+ 14 monocyte HLADR+ and cytokines 〔tumor necrosis factorα(TNFα), interleukin6( IL6),IL10,IL13〕 were respectively measured.Results:Totally,20 patients were enrolled in this study.Among them 15 survived and 5 died.After treatment with TP5,CD+ 14 monocyte HLADR was elevated in almost all the patients,including the nonsurvivors.However,only a statistically significant difference between the initial values and the final values was noted in the survivors.The levels of TNFα and IL6 dropped significantly concomitantly with the elevation of the CD+ 14 monocyte HLADR in survivors.On the contrary,in the patients who died there was a tendency of an elevation of levels of these cytokines.No significant difference was found between the initial and final levels of both IL10 and IL13 with the treatment.Conclusion: ①It was reconfirmed that the CD+ 14 monocyte HLADR could be a reliable and valuable index to judge immunosupression in septic patients and determine the effectiveness of immunostimulative therapy. ②It was reconfirmed that the level of CD+ 14 monocyte HLADR can serve as an index to predict the outcome of septic patients.③TP5,as a new immunostimulative agent used in sepsis,might be effective to revert immunosupression.However,a further clinical trial with a lar

关 键 词：脓毒症 免疫抑制 代偿性抗炎症反应综合征 CD14^+单核细胞 人类白细胞抗原-DR 胸腺5肽 

分 类 号：R631[医药卫生—外科学]