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

发布时间：2018-03-22 07:27

  本文选题：重症多发伤　切入点：多部位感染　出处：《中华医院感染学杂志》2016年11期 　论文类型：期刊论文

【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(P0.01),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。
[Abstract]:Objective to investigate the clinical significance of continuously monitoring the expression of human leukocyte antigen (DR(human leukocyte antigen-DRN) on the surface of monocytes in the prognosis of patients with severe multiple injury. Methods 54 patients with severe multiple injuries treated in ICU from February 2013 to February 2015 were selected as the study objects. The expression rate of HLA-DR on the surface of CD14 positive monocytes in peripheral blood was detected by flow cytometry on admission to hospital and on day 1 015 of the 2nd day, and was divided into multi-site infection group (n = 15) and non-multisite infection group (n = 39) according to the infection condition within 28 days. Results among 54 patients with severe multiple injuries, 15 cases had multiple site infection, and the infection rate was 27.810%. The expression rate of HLA-DR and the difference between the expression rate of HLA-DR and the rate of HLA-DR expression on admission were used to predict multisite infection in patients with severe multiple trauma. The difference was statistically significant (P 0.01), and the area under the curve was 0.804 / 0.9130.9530.680.87534A, respectively. The sensitivity of HLA-DR8 鈮，

本文编号：1647632