单核细胞HLA-DR和T淋巴细胞亚群预测严重创伤继发感染的临床研究

发布时间：2018-05-01 14:22

本文选题：创伤 + 脓毒症　；参考：《中国呼吸与危重监护杂志》2017年04期

【摘要】：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。
[Abstract]:Objective to investigate the prognostic value of the changes of HLA-DRN expression in monocytes and the proportion of T lymphocyte subsets in peripheral blood in patients with severe trauma secondary infection. Methods from June 2014 to June 2016, 26 patients with severe trauma were treated in the Department of intensive Medicine, Gulou Hospital, Medical College of Nanjing University. The expression rate of HLA-DR and the proportion of T lymphocyte subsets in peripheral blood were detected by flow cytometry on the day of admission and 5 days after admission. According to the infection condition within 28 days, the patients were divided into three groups: non-infection group, local infection group and systemic infection group. The relationship between HLA-DR expression and T lymphocyte subsets was analyzed. Results Local infection occurred in 10 cases and systemic infection in 12 cases in 26 patients with severe trauma. The infection rate was 84.6%. Compared with non-infection group and local infection group, the expression rate of HLA-DR in systemic infection group was significantly lower than that in non-infection group and local infection group. Compared with the non-infected group, the ratio of CD4 to / / CD8 ~ in local infection group and systemic infection group was significantly decreased on the 7th day. Conclusion continuous monitoring of HLA-DR expression on peripheral blood monocytes and T lymphocyte subsets in peripheral blood plays an important role in predicting secondary infection, predicting prognosis and preventing infection in patients with severe trauma.
【作者单位】：南京大学医学院附属鼓楼医院重症医学科;
【分类号】：R641

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