论文部分内容阅读
目的探讨创伤患者单核细胞表面人白细胞抗原-DR(HLA-DR)表达的变化规律及其与炎症反应的关系。方法采用流式细胞仪连续检测32例创伤患者[损伤严重度评分(ISS)＞16]伤后单核细胞HLA-DR的阳性分子的表达率,并据感染发生与否分组进行分析；同时检测白细胞介素(IL)-6和IL-10的变化。结果所有患者创伤后1 d单核细胞HLA-DR抗原为(73．67±7．32)%,显著低于正常值(P＜0．01),并于伤后4 d达到最低水平[(47．89±9．31)%]；合并感染并发症患者伤后1,2,4,7,14 d单核细胞HLA-DR抗原分别为(62．92±8．62)%、(45．34±5．96)%、(22．36±8．21)%、(25．14±5．17)%、(28．93±9．92)%,而无并发感染者分别为(75．32±6．53)%、(55．13±3．95)%、(53．21±5．36)%、(63．10±7．55)%、(88．34±8．07)%,相同时相两组比较,差异有统计学意义(P＜0．05,0．01)。创伤患者单核细胞HLA-DR表达与APACHEⅡ评分呈显著负相关(r=-0．435,P＜0．01)。创伤患者IL-10的变化和HLA- DR呈负相关,伤后2 d相关性最强(r=-0．782,P＜0．01)。结论(1)创伤后患者早期就存在免疫抑制状态；免疫抑制程度与病情严重度密切相关；(2)创伤患者CD14~+单核细胞的HLA-DR下降与创伤后感染有关；(3)创伤患者CD14~+单核细胞的HLA-DR的变化与血浆IL-10的变化有关。
Objective To investigate the variation of HLA-DR expression on mononuclear cells in trauma patients and its relationship with inflammatory reaction. Methods The expression of HLA-DR-positive mononuclear cells in 32 traumatic patients [injury severity score (ISS)> 16] was detected continuously by flow cytometry and analyzed by grouping with or without infection Changes of interleukin (IL) -6 and IL-10. Results The HLA-DR antigen level in mononuclear cells on 1 d after trauma was (73.67 ± 7.32)%, significantly lower than the normal value (P <0.01) and reached the lowest level on the 4th day after injury 47.89 ± 9.31)%]; HLA-DR antigens were 62.92 ± 8.62%, 1, 2, 4, 7 and 14 days .34 ± 5.96)%, (22.36 ± 8.21)%, (25.14 ± 5.17)% and (28.93 ± 9.92)%, respectively, while those without concurrent infection were 75.32 ± 6.53%, 55.13 ± 3.95%, 53.21 ± 5.36%, 63.10 ± 7.55%, 88.34 ± 8. 07)%, the same time phase two groups, the difference was statistically significant (P <0.05,0.01). There was a significant negative correlation between HLA-DR expression and APACHEⅡscore in trauma patients (r = -0.435, P <0.01). The change of IL-10 in traumatic patients was negatively correlated with HLA-DR, the strongest correlation was found on the 2nd day after injury (r = -0.782, P <0.01). Conclusions (1) The immunosuppressive status exists in the early post-traumatic patients; the degree of immunosuppression is closely related to the severity of the disease; (2) the decrease of HLA-DR of CD14 ~ + monocytes in traumatic patients is related to the post-traumatic infection; (3) The change of HLA-DR in patients with CD14 ~ + monocytes is related to the change of plasma IL-10.