中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2012年
1期
23-26
,共4页
抗原,CD14%HLA抗原%脓毒症%外周血干细胞移植
抗原,CD14%HLA抗原%膿毒癥%外週血榦細胞移植
항원,CD14%HLA항원%농독증%외주혈간세포이식
Antigens,CD14%HLAantigens%Sepsis%Peripheral blood stem cell transplantation
目的 观察重症脓毒症患者外周血单核细胞(PBMC)表面膜CD14(mCD14)、人类白细胞抗原( HLA)-DR及炎性因子的表达及意义.方法 选取重症脓毒症患者35例(病例组)和健康志愿者15例(对照组).于入院后第1、3、5天检测其PBMC表面mCD14、HLA-DR表达,血清肿瘤坏死因子(TNF)-α、白细胞介素(IL)-10浓度及急性生理学和慢性健康状况Ⅱ评分(APACHEⅡ)、全身性感染相关器官功能衰竭评分(SOFA评分).结果 病例组患者PBMC表面mCD14、HLA-DR表达分别为(2.61±1.59)％、( 10.25±5.35)％,明显低于对照组的(5.57±1.53)％、(59.28±14.76)％,血清TNF-α、IL-10浓度分别为(96.66±45.38)、( 149.79±77.15) ng/L,明显高于对照组的(0.12±0.00)、(5.67±2.16) ng/L,差异均有统计学意义(P＜ 0.05或＜0.01).病例组患者死亡10例,存活25例,28d病死率28.6％(10/35),死亡患者与存活患者PBMC表面mCD14、HLA-DR表达及SOFA评分、APACHEⅡ在入院后第1、3天比较差异均无统计学意义(P＞0.05),第5天存活患者PBMC表面mCD14、HLA-DR表达明显高于死亡患者[(5.12±2.03)％比(2.75±0.67)％；(35.12±9.29)％比(13.06±5.87)％ ](P＜ 0.01或＜0.05),SOFA评分、APACHEⅡ明显低于死亡患者[(4.48±1.71)分比(10.70±3.16)分；(9.36±5.57)分比(25.60±10.88)分](P＜0.01),而两者血清TNF-α、IL-10浓度在入院后第1、3、5天比较差异均无统计学意义(P＞0.05).结论 重症脓毒症患者PBMC表面mCD14、HLA-DR表达与患者预后密切相关,血清TNF-α、IL-10浓度在入院后5d内的动态变化不能反映患者疾病的演变和预后.
目的 觀察重癥膿毒癥患者外週血單覈細胞(PBMC)錶麵膜CD14(mCD14)、人類白細胞抗原( HLA)-DR及炎性因子的錶達及意義.方法 選取重癥膿毒癥患者35例(病例組)和健康誌願者15例(對照組).于入院後第1、3、5天檢測其PBMC錶麵mCD14、HLA-DR錶達,血清腫瘤壞死因子(TNF)-α、白細胞介素(IL)-10濃度及急性生理學和慢性健康狀況Ⅱ評分(APACHEⅡ)、全身性感染相關器官功能衰竭評分(SOFA評分).結果 病例組患者PBMC錶麵mCD14、HLA-DR錶達分彆為(2.61±1.59)％、( 10.25±5.35)％,明顯低于對照組的(5.57±1.53)％、(59.28±14.76)％,血清TNF-α、IL-10濃度分彆為(96.66±45.38)、( 149.79±77.15) ng/L,明顯高于對照組的(0.12±0.00)、(5.67±2.16) ng/L,差異均有統計學意義(P＜ 0.05或＜0.01).病例組患者死亡10例,存活25例,28d病死率28.6％(10/35),死亡患者與存活患者PBMC錶麵mCD14、HLA-DR錶達及SOFA評分、APACHEⅡ在入院後第1、3天比較差異均無統計學意義(P＞0.05),第5天存活患者PBMC錶麵mCD14、HLA-DR錶達明顯高于死亡患者[(5.12±2.03)％比(2.75±0.67)％；(35.12±9.29)％比(13.06±5.87)％ ](P＜ 0.01或＜0.05),SOFA評分、APACHEⅡ明顯低于死亡患者[(4.48±1.71)分比(10.70±3.16)分；(9.36±5.57)分比(25.60±10.88)分](P＜0.01),而兩者血清TNF-α、IL-10濃度在入院後第1、3、5天比較差異均無統計學意義(P＞0.05).結論 重癥膿毒癥患者PBMC錶麵mCD14、HLA-DR錶達與患者預後密切相關,血清TNF-α、IL-10濃度在入院後5d內的動態變化不能反映患者疾病的縯變和預後.
목적 관찰중증농독증환자외주혈단핵세포(PBMC)표면막CD14(mCD14)、인류백세포항원( HLA)-DR급염성인자적표체급의의.방법 선취중증농독증환자35례(병례조)화건강지원자15례(대조조).우입원후제1、3、5천검측기PBMC표면mCD14、HLA-DR표체,혈청종류배사인자(TNF)-α、백세포개소(IL)-10농도급급성생이학화만성건강상황Ⅱ평분(APACHEⅡ)、전신성감염상관기관공능쇠갈평분(SOFA평분).결과 병례조환자PBMC표면mCD14、HLA-DR표체분별위(2.61±1.59)％、( 10.25±5.35)％,명현저우대조조적(5.57±1.53)％、(59.28±14.76)％,혈청TNF-α、IL-10농도분별위(96.66±45.38)、( 149.79±77.15) ng/L,명현고우대조조적(0.12±0.00)、(5.67±2.16) ng/L,차이균유통계학의의(P＜ 0.05혹＜0.01).병례조환자사망10례,존활25례,28d병사솔28.6％(10/35),사망환자여존활환자PBMC표면mCD14、HLA-DR표체급SOFA평분、APACHEⅡ재입원후제1、3천비교차이균무통계학의의(P＞0.05),제5천존활환자PBMC표면mCD14、HLA-DR표체명현고우사망환자[(5.12±2.03)％비(2.75±0.67)％；(35.12±9.29)％비(13.06±5.87)％ ](P＜ 0.01혹＜0.05),SOFA평분、APACHEⅡ명현저우사망환자[(4.48±1.71)분비(10.70±3.16)분；(9.36±5.57)분비(25.60±10.88)분](P＜0.01),이량자혈청TNF-α、IL-10농도재입원후제1、3、5천비교차이균무통계학의의(P＞0.05).결론 중증농독증환자PBMC표면mCD14、HLA-DR표체여환자예후밀절상관,혈청TNF-α、IL-10농도재입원후5d내적동태변화불능반영환자질병적연변화예후.
Objective To observe the expression of mCD14 and human leucocyte antigen (HLA)-DR on peripheral blood mononuclear cell( PBMC ) and cytokine in severe sepsis and its significance.Methods Thirty-five patients with severe sepsis (patients group) and 15 healthy volunteers (control group)were selected in this study.The expression of mCD14,HLA-DR on PBMC,serum tumor necrosis factor (TNF)- α,interleukin(IL)-10,the total score of acute physiology and chronic health evaluation(APACHE Ⅱ )and sepsis-related organ failure assessment (SOFA) score of the patients were measured at the 1st,3rd,5th day after admission.Results The expression of mCD14 and HLA-DR on PBMC,the levels of serum TNF- α and IL-10 were ( 2.61 ± 1.59 )％,( 10.25 ± 5.35 )％,(96.66 ± 45.38) ng/L,( 149.74 ± 77.15 ) ng/L in patients group,(5.57 ± 1.53)％,(59.28 ± 14.76)％,(0.12 ±0.00) ng/L,(5.67 ±2.16) ng/L in control group,there were significant differences between two groups (P ＜ 0.05 or ＜ 0.01 ).In patients group,the mortality of 28 days was 28.6％(10/35).The expression of mCD14 and HLA-DR on PBMC,SOFA score and APACHE Ⅱ at the 1st,3rd day showed no statistical significance between non-survivor patients and survivor patients (P ＞ 0.05 ),but at 5th day the expressions of mCD14 and HLA-DR on PBMC in survivor patients were significantly higher than those in non-survivor patients [ (5.12 ± 2.03 )％ vs.(2.75 ± 0.67 )％; (35.12 ±9.29)％ vs.(13.06 ±5.87) ％](P＜0.01 or ＜ 0.05),SOFA score and APACHE Ⅱ were significantly lower than those in non-survivor patients[ (4.48 ± 1.71 ) scores vs.( 10.70 ± 3.16 ) scores; (9.36 ± 5.57 ) scores vs.(25.60 ± 10.88) scores](P＜ 0.01 ).The levels of serum TNF- α and IL-10 at the 1st,3rd,5th day showed no statistical significance between non-survivor patients and survivor patients (P ＞ 0.05).Conclusions The expressions of mCD14 and HLA-DR on PBMC in severe sepsis show closely related to the outcome.The changes of serum TNF- α and IL- 10 can not reflect the prognosis of severe sepsis in 5 days.
