重型颅脑损伤患者单核细胞人类白细胞抗原DR表达及意义
중형로뇌손상환자단핵세포인류백세포항원DR표체급의의
The expression and significance of monocyte human leukocyte antigen DR in patients with severe craniocerebral injury
  • 万方数据
    中国医师进修杂志 중국의사진수잡지
    CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
    2012年 20期 3-6 ,共4页

    苗雨露%张明霞%余少雄%钟利明%赵万%刘泽%尹勇%黄斌

    묘우로%장명하%여소웅%종리명%조만%류택%윤용%황빈

    颅脑损伤%HLA抗原%流式细胞术%感染 顱腦損傷%HLA抗原%流式細胞術%感染
    로뇌손상%HLA항원%류식세포술%감염
    Craniocerebral trauma%HLA antigens%Flow cytometry%Infection
    目的 研究重型颅脑损伤患者伤后外周血单核细胞人类白细胞抗原DR(HLA-DR)表达变化规律,探讨HLA-DR表达与感染和预后的关系.方法 选取颅脑损伤患者90例(试验组),按入院时格拉斯哥昏迷量表(GCS)评分将试验组分为试验1组(GCS评分13～15分)、试验2组(GCS评分9～12分)、试验3组(GCS评分3～8分),每组30例,分别为轻、中、重型颅脑损伤患者.选择同期健康体检者30例作为对照组.采用流式细胞仪检测试验各组入院后1、3、7、14d及对照组体检当天外周血单核细胞HLA-DR表达情况,入院后30 d统计试验组患者感染率、治愈率、残疾率、植物状态率、病死率.结果 试验1组、试验2组入院后1、3、7、14d外周血单核细胞HLA-DR表达[分别为(28.11±2.37)、(26.45±1.63)、(27.75±1.83)、(27.15±2.17) MCF,(29.34±2.07)、(27.55±1.63)、(28.42±1.94)、(29.46±2.12) MCF]与对照组体检当天[(29.18±1.91) MCF]比较差异无统计学意义(P＞0.05),试验1组、试验2组入院后1、3、7d及对照组体检当天HLA-DR表达与试验3组入院后1、3、7d[分别为(18.02±1.78)、( 16.05±1.97)、( 20.76±1.65) MCF]比较差异有统计学意义(P＜0.05),但试验1组、试验2组入院后14d及对照组体检当天与试验3组入院后14d[(26.13±2.15) MCF]比较差异无统计学意义(P＞0.05).试验1组、试验2组、试验3组感染率分别为0、3.6％( 1/28)、82.8％(24/29),治愈率分别为100.0％(30/30)、100.0％(28/28)、10.3％(3/29),残疾率分别为0、0、41.4％(12/29),植物状态率分别为0、0、20.7％(6/29),病死率分别为0、0、27.6％(8/29),试验1组与试验2组感染率、治愈率、残疾率、植物状态率、病死率比较差异无统计学意义(P＞0.05),但试验1组、试验2组与试验3组比较差异均有统计学意义(P＜0.05).结论 轻、中型颅脑损伤患者入院后1、3、7、14d外周血单核细胞HLA-DR表达变化不明显,重型颅脑损伤患者HLA-DR表达伤后1d开始下降、3d明显下降、7d开始升高、14d恢复到正常水平,重型颅脑损伤患者HLA-DR表达下降与感染有相关性,并预示预后不良.
    목적 연구중형로뇌손상환자상후외주혈단핵세포인류백세포항원DR(HLA-DR)표체변화규률,탐토HLA-DR표체여감염화예후적관계.방법 선취로뇌손상환자90례(시험조),안입원시격랍사가혼미량표(GCS)평분장시험조분위시험1조(GCS평분13～15분)、시험2조(GCS평분9～12분)、시험3조(GCS평분3～8분),매조30례,분별위경、중、중형로뇌손상환자.선택동기건강체검자30례작위대조조.채용류식세포의검측시험각조입원후1、3、7、14d급대조조체검당천외주혈단핵세포HLA-DR표체정황,입원후30 d통계시험조환자감염솔、치유솔、잔질솔、식물상태솔、병사솔.결과 시험1조、시험2조입원후1、3、7、14d외주혈단핵세포HLA-DR표체[분별위(28.11±2.37)、(26.45±1.63)、(27.75±1.83)、(27.15±2.17) MCF,(29.34±2.07)、(27.55±1.63)、(28.42±1.94)、(29.46±2.12) MCF]여대조조체검당천[(29.18±1.91) MCF]비교차이무통계학의의(P＞0.05),시험1조、시험2조입원후1、3、7d급대조조체검당천HLA-DR표체여시험3조입원후1、3、7d[분별위(18.02±1.78)、( 16.05±1.97)、( 20.76±1.65) MCF]비교차이유통계학의의(P＜0.05),단시험1조、시험2조입원후14d급대조조체검당천여시험3조입원후14d[(26.13±2.15) MCF]비교차이무통계학의의(P＞0.05).시험1조、시험2조、시험3조감염솔분별위0、3.6％( 1/28)、82.8％(24/29),치유솔분별위100.0％(30/30)、100.0％(28/28)、10.3％(3/29),잔질솔분별위0、0、41.4％(12/29),식물상태솔분별위0、0、20.7％(6/29),병사솔분별위0、0、27.6％(8/29),시험1조여시험2조감염솔、치유솔、잔질솔、식물상태솔、병사솔비교차이무통계학의의(P＞0.05),단시험1조、시험2조여시험3조비교차이균유통계학의의(P＜0.05).결론 경、중형로뇌손상환자입원후1、3、7、14d외주혈단핵세포HLA-DR표체변화불명현,중형로뇌손상환자HLA-DR표체상후1d개시하강、3d명현하강、7d개시승고、14d회복도정상수평,중형로뇌손상환자HLA-DR표체하강여감염유상관성,병예시예후불량.
    Objective To study the expression changes of peripheral blood monocyte human leukocyte antigen DR (HLA-DR) in patients with severe craniocerebral injury,and investigate the correlation between HLA-DR expression and infection and prognosis.Methods Ninety patients with craniocerebral injury were selected as experimental group and were divided according to the Glasgow coma scale (GCS) score after hospitalization into experimental group 1 (GCS score 13-15 scores ),experimental group 2 (GCS score 9-12 scores) and experimental group 3 (GCS score 3-8 scores) with 30 patients each,which were moderate,medium,severe craniocerebral injury,respectively.Thirty healthy people were chosen at the same period as control group.The HLA-DR expression of experimental group was detected after 1,3,7 and 14 d of admission by flow cytometry,and the HLA-DR expression of control group was detected on the day they got physical examination.The rates of infection,cure,disability,vegetative state and mortality were counted after 30 d of admission.Results The HLA-DR expressions in experimental group 1 and experimental group 2 after 1,3,7,14 d of admission were (28.11 ± 2.37),(26.45 ± 1.63),(27.75 ± 1.83),(27.15 ± 2.17) MCF and (29.34 ±2.07),(27.55 ± 1.63),(28.42 ± 1.94),(29.46 ±2.12) MCF,which had no statistical difference compared with that in control group [(29.18 ± 1.91 ) MCF](P＞ 0.05).The HLA-DR expressions in experimental group 1 and experimental group 2 after 1,3,7 d of admission and control group had statistical differences compared with those in experimental group 3 after 1,3,7 d of admission [(18.02 ± 1.78),(16.05 ± 1.97 ),(20.76 ± 1.65) MCF ] (P ＜ 0.05).The HLA-DR expressions in experimental group 1 and experimental group 2 after 14 d of admission and control group had no statistical significance compared with that in experimental group 3 after 14 d of admission [ (26.13 ± 2.15) MCF](P＞ 0.05).The infection rates of experimental group 1,experimental group 2 and experimental group 3 were 0,3.6％(1/28),82.8％(24/29),respectively,while the cure rates were 100.0％ (30/30),100.0％ (28/28),10.3％ (3/29),the disability rates were 0,0,41.4％ (12/29),the vegetative state rates were 0,0,20.7％ (6/29),and the mortality were 0,0,27.6％ (8/29).There was no statistical significance in the rates of infection,cure,disability,vegetative state and mortality between experimental group 1 and experimental group 2 (P＞ 0.05 ).While there was statistical differences in the rates of infection,cure,disability,vegetative state and mortality among experimental group 1,experimental group 2 and experimental group 3 (P ＜ 0.05).Conclusions The HLA-DR expression changes of patients with moderate and medium craniocerebral injury after 1,3,7,14 d of admission are not significant.The HLA-DR expression of patients with severe craniocerebral injury begins to decline from 1 d after injury,declines obviously at 3 d,increases from 7 d,returns to normal level at 14 d.The decline of HLA-DR expression in patients with severe craniocerebral injury is correlated with the infection,and predicts poor prognosis.
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