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目的探讨CD14基因多态性与大面积烧伤患者预后及人白细胞抗原-DR(HLA- DR)表达的相关程度。方法采集103例烧伤体表总面积＞30%患者血标本,通过聚合酶链反应-限制性片断长度多态性方法检测CD14-159C/T基因多态性。采用流式细胞技术(使用QuantiBRITE~TM) Anti-HLA-DR PE~*/Anti-Monocyte PerCP-Cy5．5单克隆抗体)对患者烧伤后1,3,5,7,14,21,28 d单核细胞表面HLA-DR抗体的结合量进行定量分析。结果在特重度烧伤患者中(71例),CD14基因多态性携带TY型的患者脓毒症发生率(72．2%)及死亡率(50．0%)高于TC基因型(分别为60．9%、23．9%)和CC基因型(分别为57．1%、28．6%)(P＜0．05)。特重度烧伤患者中脓毒症组(45例)HLA-DR结合抗体量伤后逐步下降,而非脓毒症(26例)组伤后第5天以后持续升高,伤后第3,7,14,21,28 d两组比较,差异有统计学意义(P＜0．01)。伤后3,14,21 d,CC纯合子患者HLA-DR抗体结合量均明显高于TY纯合子(P＜0．05),而与TC型比较,差异无统计学意义(P＞0．05)。结论CD14-159C/T多态性与严重烧伤后并发脓毒症及患者预后有关,TT纯合子可能是特重烧伤后机体免疫应答反应异常的相关“易感基因”之一。
Objective To investigate the correlation between the polymorphism of CD14 gene and the prognosis of large area burn patients and the expression of human leukocyte antigen-DR (HLA-DR). Methods The blood samples of 103 patients with burn surface area> 30% were collected and the polymorphisms of CD14-159C / T were detected by polymerase chain reaction - restriction fragment length polymorphism. Anti-HLA-DR PE ~ * / Anti-Monocyte PerCP-Cy5.5 Monoclonal Antibodies were detected by flow cytometry (using QuantiBRITE ~ TM) on day 1,3,5,7,14,21,28 after burn The amount of bound HLA-DR antibody on the surface of monocytes was quantitatively analyzed. Results In patients with extremely severe burn (71 cases), the incidence of sepsis (72.2%) and mortality (50.0%) in CD14 genotype carriers with TY genotype were higher than those in genotype TC 60.9%, 23.9%) and CC genotype (57.1%, 28.6%, respectively) (P <0.05). In severe sepsis patients, the amount of HLA-DR-binding antibody in sepsis group (45 cases) gradually decreased after injury, while the non-sepsis (26 cases) group continued to increase after 5 days, , 14, 21, 28 d, the difference was statistically significant (P <0.01). The amount of HLA-DR antibody binding in CC homozygous patients was significantly higher than TY homozygotes at 3, 14, and 21 days after injury (P <0.05), but no significant difference compared with TC type (P> 0.05). 05). Conclusions CD14-159C / T polymorphism is associated with sepsis and prognosis in patients with severe burn. TT homozygote may be one of the related “susceptibility genes” in the abnormal immune response after severe burn.