單核細胞 HLA-DR 和 T 淋巴細胞亞群預測嚴重創傷繼發感染的臨床研究_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

虞竹溪 , 郝迎迎 , 劉寧 ,  顧勤

南京大學醫學院附屬鼓樓醫院重癥醫學科（江蘇南京 210008）;

Corresponding?author：

顧勤, Email: icuguqin1133@hotmail.com

Keywords：

創傷; 膿毒癥; 單核細胞; 人類白細胞抗原; T淋巴細胞亞群

DOI：

10.7507/1671-6205.201608042

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目的探討連續監測單核細胞人類白細胞抗原 DR（HLA-DR）表達率變化及外周血 T 淋巴細胞亞群比例變化對嚴重創傷繼發感染的預測價值。方法納入 2014 年 6 月至 2016 年 6 月南京大學醫學院附屬鼓樓醫院重癥醫學科收治的 26 例嚴重創傷患者，用流式細胞學方法檢測其入院當天及第 3、5、7 d 外周血 HLA-DR 表達率及 T 淋巴細胞亞群比例，根據患者 28 d 內感染情況分為非感染組、局部感染組和全身感染組，分析 HLA-DR 表達率變化規律和 T 淋巴細胞亞群比例變化規律與感染的關系。結果 26 例嚴重創傷患者中發生局部感染 10 例，全身感染12 例，感染率達 84.6%。與非感染組及局部感染組比較，全身感染組第 7 d 的 HLA-DR 表達率顯著降低。與非感染組比較，局部感染組和全身感染組第 7 d 的 CD4⁺/CD8⁺ 比例顯著降低。結論外周血單核細胞表面 HLA-DR 表達率及外周血 T 淋巴細胞亞群比例的連續監測在預測嚴重創傷患者繼發感染、判斷預后和預防治療感染中具重要價值。

Citation： 虞竹溪, 郝迎迎, 劉寧, 顧勤. 單核細胞 HLA-DR 和 T 淋巴細胞亞群預測嚴重創傷繼發感染的臨床研究. Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(4): 401-403. doi: 10.7507/1671-6205.201608042 Copy

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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.	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.	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.
15.	姚詠明. 多器官功能障礙綜合征發病機制研究新進展. 中華急診醫學雜志, 2001, 10(1): 63-65.
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.
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.
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.
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.
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.
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.	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.

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. Osborn TM, Tracy JK, Dunne JR, et al. Epidemiologyof sepsis in patients with traumatic injury. Crit Care Med, 2004, 32(11):2234-2240.
3. Tschoeke SK, Ertel W. Immunoparalysis after multiple trauma. Injury, 2007, 38(12):1346-1357.
4. Keel M, Trentz O. Pathophysiology of polytrauma. Injury, 2005, 36(6):691-709.
5. Adib-Conquy M, Cavaillon JM. Compensatory anti-inflammatory response syndrome. Thromb Haemost, 2009, 101(1):36-47.
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.
7. Ward NS, Casserly B, Ayala A.The compensatory anti-inflammatory response syndrome (CARS) in critically ill patients. Clin Chest Med, 2008, 29(4):617-625, viii.
8. Kox WJ, Volk T, Kox SN, et al. Immunomodulatory therapies in sepsis.Intensive Care Med, 2000, 26 Suppl 1:124-128.
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. Hotchkiss RS, Karl IE.The pathophysiology and treatment of sepsis. N Engl J Med, 2003, 348(2):138-150.
11. 林洪遠, 郭旭升, 姚詠明, 等. CD14+單核細胞人類白細胞抗原- DR 預測膿毒癥預后及指導免疫調理治療的初步臨床研究. 中國危重病急救醫學, 2003, 15(3): 135-138.
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. 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. 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.
15. 姚詠明. 多器官功能障礙綜合征發病機制研究新進展. 中華急診醫學雜志, 2001, 10(1): 63-65.
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.
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.
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.
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.
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.
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. 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.

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單核細胞 HLA-DR 和 T 淋巴細胞亞群預測嚴重創傷繼發感染的臨床研究

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