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目的探讨连续监测单核细胞人类白细胞抗原DR(HLA-DR)表达率变化及外周血T淋巴细胞亚群比例变化对严重创伤继发感染的预测价值。方法纳入2014年6月至2016年6月南京大学医学院附属鼓楼医院重症医学科收治的26例严重创伤患者,用流式细胞学方法检测其入院当天及第3、5、7 d外周血HLA-DR表达率及T淋巴细胞亚群比例,根据患者28 d内感染情况分为非感染组、局部感染组和全身感染组,分析HLA-DR表达率变化规律和T淋巴细胞亚群比例变化规律与感染的关系。结果 26例严重创伤患者中发生局部感染10例,全身感染12例,感染率达84.6%。与非感染组及局部感染组比较,全身感染组第7 d的HLA-DR表达率显著降低。与非感染组比较,局部感染组和全身感染组第7 d的CD4~+/CD8~+比例显著降低。结论外周血单核细胞表面HLA-DR表达率及外周血T淋巴细胞亚群比例的连续监测在预测严重创伤患者继发感染、判断预后和预防治疗感染中具重要价值。
Objective To investigate the predictive value of continuous monitoring of the expression of HLA-DR in mononuclear cells and the ratio of T lymphocyte subsets in peripheral blood to the prognosis of severe traumatic secondary infection. Methods Twenty-six patients with severe trauma admitted to Department of Critical Care Medicine, Drum Tower Hospital Affiliated to Nanjing University Medical College from June 2014 to June 2016 were enrolled in this study. Flow cytometry was used to detect the peripheral blood HLA -DR and T lymphocyte subsets were divided into non-infected group, local infection group and systemic infection group according to the infection status within 28 days. The changes of HLA-DR expression rate and T lymphocyte subsets proportion were analyzed Relationship with infection. Results In 26 severe trauma patients, 10 cases of local infection and 12 systemic infection were found, the infection rate was 84.6%. Compared with non-infected group and local infection group, the expression of HLA-DR on the 7th day in the systemic infection group was significantly lower. Compared with the non-infected group, the proportion of CD4 ~ + / CD8 ~ + on the 7th day in the local infection group and the systemic infection group was significantly lower. Conclusion The continuous monitoring of the expression of HLA-DR on peripheral blood mononuclear cells and the proportion of T lymphocyte subsets in peripheral blood is of great value in predicting the secondary infection, judging the prognosis and preventing and treating the infection in severe trauma patients.