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目的研究重度脓毒症患者CD14+单核细胞HLA-DR水平及其与预后的相关性。方法选择ICU确诊为重度脓毒症的患者91例,监测患者第1,4,7天外周血CD14+单核细胞HLA-DR表达,记录患者APACHEⅡ评分、Marshall评分和28d预后。结果28d内死亡34例,28d病死率为37.4%。死亡组HLA-DR均明显低于存活组(P<0.001)且持续处于低水平的状态,APACHEⅡ评分和Marshall评分均明显高于存活组(P<0.05,P<0.001);存活组HLA-DR逐渐升高(P<0.01),APACHEⅡ评分和Marshall评分逐渐降低(P<0.001),第7天与第1天比较3项差异均有显著性(P<0.001),且第4天APACHEⅡ评分及Marshall评分与第1天比较差异有显著性(P<0.001)。Spearman相关分析显示,全程HLA-DR与APACHEⅡ评分和Marshall评分均呈负相关(r=-0.237,P=0.000;r=-0.368,P=0.000);在存活组内,全程HLA-DR与呼吸机通气时间和住ICU时间均呈负相关(r=-0.161,P=0.043;r=-0.190,P=0.017)。结论重度脓毒症患者单核细胞HLA-DR水平对患者的预后具有预见性,水平低者病死率高,呼吸机通气时间和住ICU时间长。
Objective To investigate the level of HLA-DR of CD14 + monocytes in patients with severe sepsis and its correlation with prognosis. Methods 91 patients with ICSI confirmed severe sepsis were selected. The HLA-DR expression of CD14 + monocytes was monitored on the 1st, 4th and 7th day in the patients. The APACHEⅡscore, Marshall score and prognosis of the 28th day were recorded. Results 34 cases died within 28 days, 28 days mortality was 37.4%. The HLA-DR in the death group was significantly lower than that in the surviving group (P <0.001), and remained low. The APACHEⅡand Marshall scores were significantly higher in the death group than in the surviving group (P <0.05, P <0.001) APACHEⅡscore and Marshall score decreased gradually (P <0.001). There was significant difference between the 7th day and the 1st day (P <0.001), and the APACHEⅡscore of the 4th day and There was significant difference between the Marshall score and the first day (P <0.001). Spearman correlation analysis showed that HLA-DR was negatively correlated with APACHEⅡ score and Marshall score (r = -0.237, P = 0.000; r = -0.368, P = 0.000) Ventilation time and ICU were negatively correlated (r = -0.161, P = 0.043; r = -0.190, P = 0.017). Conclusion HLA-DR levels in monocytes in patients with severe sepsis are predictive of the prognosis of patients. The patients with low levels of sepsis have high mortality, ventilator ventilation and long ICU stay.