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目的:探讨烧伤延迟复苏对CD14+单核细胞人类白细胞组织相容性抗原-DR(HLA-DR)表达率和外周血淋巴细胞凋亡率的影响及其机制。方法:50例烧伤面积大于30%的烧伤患者,按伤后是否及时有效复苏分为延迟复苏组和非延迟复苏组,于伤后1、3、7、14、28d取外周血。流式细胞术检测CD14+单核细胞HLA-DR表达率和外周血淋巴细胞凋亡率。20例健康体检者外周血检测上述指标作为对照。结果:烧伤患者外周血CD14+单核细胞HLA-DR表达率明显低于正常对照组(P均<0.01),延迟复苏患者明显低于非延迟复苏患者(P<0.05或P<0.01)。烧伤患者外周血淋巴细胞凋亡率明显高于正常对照组(P<0.05),延迟复苏患者明显高于非延迟复苏患者,伤后7和28d差异有显著性(P<0.05)。结论:烧伤患者免疫功能低下,动态检测患者的免疫功能状态对患者预后具有指导意义。
OBJECTIVE: To investigate the effect and mechanism of delaying resuscitation on the expression of human leukocyte antigen-DR (HLA-DR) and peripheral blood lymphocyte apoptosis in CD14 + monocytes. Methods: Fifty burn patients with burn area more than 30% were divided into delayed recovery group and non-delayed recovery group according to whether the injury was timely and effective recovery. Peripheral blood was taken at 1, 3, 7, 14 and 28 days after injury. The expression of HLA-DR on CD14 + monocytes and the rate of peripheral blood lymphocyte apoptosis were detected by flow cytometry. Peripheral blood samples from 20 healthy volunteers were used as control. Results: The expression of HLA-DR in peripheral blood CD14 + monocytes in burn patients was significantly lower than that in normal controls (all P <0.01). The patients with delayed resuscitation were significantly lower than non-delayed resuscitation patients (P <0.05 or P <0.01). The apoptosis rate of peripheral blood lymphocytes in burn patients was significantly higher than that in normal controls (P <0.05). The patients with delayed resuscitation were significantly higher than those without delayed resuscitation. The difference was significant at 7 and 28 days after burn (P <0.05). Conclusion: Immune function is low in burn patients, and dynamic detection of patients’ immune function status is of guiding significance for the prognosis of patients.