目的 探讨连续监测单核细胞人类白细胞抗原 DR（HLA-DR）表达率变化及外周血 T 淋巴细胞亚群比例变化对严重创伤继发感染的预测价值。 方法 纳入 2014 年 6 月至 2016 年 6 月南京大学医学院附属鼓楼医院重症医学科收治的 26 例严重创伤患者，用流式细胞学方法检测其入院当天及第 3、5、7 d 外周血 HLA-DR 表达率及 T 淋巴细胞亚群比例，根据患者 28 d 内感染情况分为非感染组、局部感染组和全身感染组，分析 HLA-DR 表达率变化规律和 T 淋巴细胞亚群比例变化规律与感染的关系。 结果 26 例严重创伤患者中发生局部感染 10 例，全身感染12 例，感染率达 84.6%。与非感染组及局部感染组比较，全身感染组第 7 d 的 HLA-DR 表达率显著降低。与非感染组比较，局部感染组和全身感染组第 7 d 的 CD4+/CD8+ 比例显著降低。 结论 外周血单核细胞表面 HLA-DR 表达率及外周血 T 淋巴细胞亚群比例的连续监测在预测严重创伤患者继发感染、判断预后和预防治疗感染中具重要价值
References
[1]
1. Kauvar DS, Wade CE. The epidemiology and modern management of traumatic hemorrhage: US and international perspectives. Crit Care, 2005, 9(Suppl 5):S1-9.
[2]
2. Osborn TM, Tracy JK, Dunne JR, et al. Epidemiologyof sepsis in patients with traumatic injury. Crit Care Med, 2004, 32(11):2234-2240.
[3]
3. Tschoeke SK, Ertel W. Immunoparalysis after multiple trauma. Injury, 2007, 38(12):1346-1357.
[4]
4. Keel M, Trentz O. Pathophysiology of polytrauma. Injury, 2005, 36(6):691-709.
[5]
5. Adib-Conquy M, Cavaillon JM. Compensatory anti-inflammatory response syndrome. Thromb Haemost, 2009, 101(1):36-47.
[6]
6. Bone RC.Immunologic dissonance: a continuing evolution in our understanding of the systemic inflammatory response syndrome (SIRS) and the multiple organ dysfunction syndrome (MODS). Ann Intern Med, 1996, 125(8):680-687.
8. Kox WJ, Volk T, Kox SN, et al. Immunomodulatory therapies in sepsis.Intensive Care Med, 2000, 26 Suppl 1:124-128.
[9]
9. Munford RS, Pugin J. Normal responses to injury prevent systemic inflammation and can be immunosuppressive. Am J Respir Crit Care Med, 2001, 163(2):316-321.
[10]
10. Hotchkiss RS, Karl IE.The pathophysiology and treatment of sepsis. N Engl J Med, 2003, 348(2):138-150.
12. Volk HD, Reinke P, D？cke WD. Immunological monitoring of the inflammatory process: Which variables? When to assess? Eur J Surg Suppl, 1999, (584): 70-72.
[13]
13. Volk HD, Reinke P, Krausch D, et al. Monocyte deactivation-rationale for a new therapeutic strategy in sepsis. Intensive Care Med, 1996, 22(Suppl 4):S474-S481.
[14]
18. Harms H, Prass K, Meisel C, et al. Preventive antibacterial therapy in acute ischemic stroke: a randomized controlled trial. PLoS One, 2008, 3(5):e2158.
[15]
19. Giannoudis PV, Smith RM, Perry SL, et al.Immediate IL-10 expression following major orthopaedic trauma: relationship to anti-inflammatory response and subsequent development of sepsis. Intensive Care Med, 2000, 26(8):1076-1081.
[16]
20. Huschak G, ZurNieden K, Stuttmann R, et al. Changes in monocytic expression of aminopeptidase N/CD13 after major trauma. Clin Exp Immunol, 2003, 134(3):491-496.
[17]
14. Monneret G, Venet F, Pachot A, et al.Monitoring immune dysfunctions in the septic patient: a new skin for the old ceremony. Mol Med, 2008, 14(1-2):64-78.
16. Efron PA, Matsumoto T, McAuliffe PF, et al. Major hepatectomy induces phenotypic changes in circulating dendritic cells and monocytes. J Clin Immunol, 2009, 29(5):568-581.
[20]
17. Yang HM, Yu Y, Chai JK, et al. Low HLA-DR expression on CD14+ monocytes of burn victims with sepsis, and the effect of carbachol in vitro. Burns, 2008, 34(8):1158-1162.
[21]
21. Hershman MJ, Cheadle WG, Kuftinec D, et al. An outcome predictive score for sepsis and death following injury. Injury, 1988, 19(4):263-266.
[22]
22. Urra X, Cervera A, Villamor N, et al. Harms and benefits of lymphocyte subpopulations in patients with acute stroke. Neuroscience, 2009, 158(3):1174-1183.
