摘要
目的 探讨创伤患者单核细胞人类白细胞抗原 DR(HL A DR)抗原分子的表达变化规律 ,及其对伤后感染并发症的预测价值。方法 应用流式细胞仪连续监测 5 4例创伤患者伤后单核细胞 HL A DR抗原分子的表达 ,并根据创伤严重程度分组进行分析。另对 34例严重创伤患者 ,根据其感染发生与否及严重程度分组进行分析。结果 创伤患者伤后单核细胞表达 HL A DR的阳性细胞率和平均荧光强度均出现降低 ,以伤后 2 d达到低谷 ,之后逐渐恢复 ;与健康对照相比 ,中度和重度创伤患者单核细胞 HL A DR抗原分子出现明显的低表达 ;轻度创伤患者与健康对照相比 ,重度与中度创伤患者相比 ,HL A DR的表达变化均无明显的差异。另外 ,严重创伤患者单核细胞 HL A DR的表达变化与感染并发症发生与否及严重程度有明显的相关性 ;非感染患者伤后 2 d单核细胞 HL A DR的表达降到最低 ,随后逐渐恢复正常 ;局部感染患者伤后前 4 d单核细胞 HL A DR的表达明显低于非感染患者 ,6 d后逐渐恢复正常 ;并发全身感染患者 ,伤后单核细胞 HL A DR的表达阳性细胞率于伤后 1～ 14 d,平均荧光强度于伤后 2～ 14 d均明显低于局部感染患者。死亡的 2例患者 ,单核细胞 HL A DR的表达持续低下直至死亡。结论 严重创伤患者单核细胞 HL A DR分子表达量明显降?
ObjectiveTo observe the changes of human leukocyte antigen DR(HLADR) expression in monocytes of trauma patients and its value of prediction on infection complications. MethodsFiftyfour trauma patients were divided into three groups according to severity of injury: severe trauma group 〔injury severity score(ISS)≥25〕, moderate trauma group(16≤ISS<25) and mild trauma group(ISS<16). In addition , 34 severe trauma patients(ISS≥16) were divided into three groups according to infection or not: no infection group, localized infection group and systemic infection group. Blood samples were collected immediately after admission and serially at 8:30 to 9:00 a.m.on days 1, 2, 4, 6, 8, 14 after admission, and monocyte HLADR expression was determined with monoclonal staining and flow cytometry. Results The HLADR expression in monocytes was reduced in the trauma patients. The lowest levels of HLADR were recorded on day 2 after trauma. Subsequently HLADR expression in monocytes increased gradually . During the whole observation, the HLADR expression was significantly decreased in both severe trauma group and moderate trauma group versus control group, but no significant differences were found between severe trauma group and moderate trauma group, mild trauma group and control group. Immediately after trauma , HLADR expression in monocytes was significantly lower in the localized infection group than that in the patients without infection, and lasted until day 4 after trauma. The mean fluorescence intensity of HLADR expression in monocytes on the day 2 to 14 after trauma, the percentage of HLADR monocytes on the day 1 to 14 after trauma were significantly lower in the systemic infection group than those in the localized infection group. The level of HLADR expression in monocyte in the 2 died trauma patients was lowered till died. ConclusionIn severe trauma patients, the HLADR expression in monocytes is significantly decreased, and decreased levels of HLADR expression in monocytes might be the early indicators of an immune deviation associated with the development of infection complications and prognosis.
出处
《中国危重病急救医学》
CAS
CSCD
2004年第4期193-197,共5页
Chinese Critical Care Medicine
基金
国家自然科学基金资助项目 (3 0 170 3 67
3 0 2 0 0 2 70 )
全军"十五"面上课题基金资助项目 (0 1MB113 )
关键词
创伤
HLA-DR
感染并发症
trauma
human leukocyte antigen-DR
infection complication
