性激素对严重腹腔感染患者人白细胞-DR抗原和可溶性髓系细胞触发受体-1以及预后的影响
성격소대엄중복강감염환자인백세포-DR항원화가용성수계세포촉발수체-1이급예후적영향
The influence of sex hormones on human leukocyte antigen-DR, soluble myeloid cell receptor-1 and prognosis in patients with severe intra-abdominal infection
  • 万方数据
    中国危重病急救医学 중국위중병급구의학
    CHINESE CRITICAL CARE MEDICINE
    2012年 8期 461-464 ,共4页

    傅强%杜超%巩传勇%王娜

    부강%두초%공전용%왕나

    雌二醇%泌乳素%睾酮%人白细胞DR抗原%可溶性髓系细胞触发受体-1%感染%预后 雌二醇%泌乳素%睪酮%人白細胞DR抗原%可溶性髓繫細胞觸髮受體-1%感染%預後
    자이순%비유소%고동%인백세포DR항원%가용성수계세포촉발수체-1%감염%예후
    Estradiol%Prolactin%Testosterone%Human leukocyte antigen-DR%Soluble myeloid cell receptor-1%Infection%Prognosis
    目的 评估血清雌二醇、泌乳素及睾酮等性激素水平对严重腹腔感染患者人白细胞DR抗原(HLA-DR)、可溶性髓系细胞触发受体-1(sTREM-1)以及预后的影响,进而评价性激素的临床应用价值.方法 选择2009年7月10日至2010年2月9日天津市南开医院外科重症监护病房( ICU)收治的73例严重腹腔感染患者,入院72 h内测定血清雌二醇、泌乳素以及睾酮水平(放射免疫法)；根据各指标水平分为雌二醇升高组(38例)和未升高组(35例)、泌乳素升高组(28例)和未升高组(45例)、睾酮降低组(33例)和未降低组(40例),记录各组患者入组时HLA-DR(流式细胞术)、sTREM-1(酶联免疫吸附试验)、急性生理学与慢性健康状况评分系统Ⅱ( APACHEⅡ)评分,以及住院时间、住ICU时间、住院费用和28 d病死率.结果 与雌二醇未升高组相比,雌二醇升高组患者HLA-DR 显著降低[(61.22±22.39)％比(75.09±14.85)％],sTREM-1(ng/L)显著增高(291.59±148.13比216.48±124.82),APACHEⅡ评分(分)明显下降(11.47±6.88比15.36±8.79),住院费用(万元)明显增加(10.98±8.15比6.25±3.51),住ICU时间(d)明显缩短(8.56±4.05比12.17±7.99),28 d病死率明显下降(10.00％比32.75％,P＜0.05或P＜0.01)；与泌乳素未升高组相比,泌乳素升高组患者HLA-DR明显降低[(61.19±21.50)％比(72.02±18.49)％],sTREM-1显著增高(307.92±173.93比223.01±106.93),住院费用明显减少(7.75±3.52比11.36±8.24),住ICU时间显著缩短(9.14±3.15比13.24±2.16,均P＜ 0.05)；与睾酮未降低组相比,睾酮降低组患者HLA-DR显著升高[(74.69±14.72)％比(62.24±22.54)％],sTREM-1明显降低(208.77±77.80比294.20±169.36),APACHEⅡ评分明显下降(10.57±6.97比15.39±9.46),住院费用明显减少(7.67±3.81比11.19±8.05),28 d病死率显著降低(0比30.14％,P＜0.05或P＜0.01).结论 严重腹腔感染早期血清雌二醇、泌乳素及睾酮水平对患者免疫炎症反应以及预后均有显著影响,具有较大的临床应用前景.
    목적 평고혈청자이순、비유소급고동등성격소수평대엄중복강감염환자인백세포DR항원(HLA-DR)、가용성수계세포촉발수체-1(sTREM-1)이급예후적영향,진이평개성격소적림상응용개치.방법 선택2009년7월10일지2010년2월9일천진시남개의원외과중증감호병방( ICU)수치적73례엄중복강감염환자,입원72 h내측정혈청자이순、비유소이급고동수평(방사면역법)；근거각지표수평분위자이순승고조(38례)화미승고조(35례)、비유소승고조(28례)화미승고조(45례)、고동강저조(33례)화미강저조(40례),기록각조환자입조시HLA-DR(류식세포술)、sTREM-1(매련면역흡부시험)、급성생이학여만성건강상황평분계통Ⅱ( APACHEⅡ)평분,이급주원시간、주ICU시간、주원비용화28 d병사솔.결과 여자이순미승고조상비,자이순승고조환자HLA-DR 현저강저[(61.22±22.39)％비(75.09±14.85)％],sTREM-1(ng/L)현저증고(291.59±148.13비216.48±124.82),APACHEⅡ평분(분)명현하강(11.47±6.88비15.36±8.79),주원비용(만원)명현증가(10.98±8.15비6.25±3.51),주ICU시간(d)명현축단(8.56±4.05비12.17±7.99),28 d병사솔명현하강(10.00％비32.75％,P＜0.05혹P＜0.01)；여비유소미승고조상비,비유소승고조환자HLA-DR명현강저[(61.19±21.50)％비(72.02±18.49)％],sTREM-1현저증고(307.92±173.93비223.01±106.93),주원비용명현감소(7.75±3.52비11.36±8.24),주ICU시간현저축단(9.14±3.15비13.24±2.16,균P＜ 0.05)；여고동미강저조상비,고동강저조환자HLA-DR현저승고[(74.69±14.72)％비(62.24±22.54)％],sTREM-1명현강저(208.77±77.80비294.20±169.36),APACHEⅡ평분명현하강(10.57±6.97비15.39±9.46),주원비용명현감소(7.67±3.81비11.19±8.05),28 d병사솔현저강저(0비30.14％,P＜0.05혹P＜0.01).결론 엄중복강감염조기혈청자이순、비유소급고동수평대환자면역염증반응이급예후균유현저영향,구유교대적림상응용전경.
    Objective To evaluate the influence of serum estradiol,prolactin and testosterone levels on human leukocyte antigen-DR ( HLA-DR ),soluble myeloid cell receptor-1 (sTREM-1) and prognosis in patients with severe abdominal infection,in order to evaluate the clinical value of the above-mentioned sex hormones.Methods From July 10,2009 to February 9,2010,73 cases with severe intra-abdominal infections hospitalized in surgical intensive care unit ( ICU ) of Tianjin Nankai Hospital were enrolled.Within 72 hours after enrollment,serum estradiol,prolactin and testosterone levels were detected by radioimmunoassay.Based on their levels,all the cases were divided into increased estradiol group ( n=38 ) and non-increased estradiol group ( n=35 ),increased prolactin group ( n=28 )and non-increased prolactin group ( n=45 ),decreased testosterone group (n=33) and non-decreased testosterone group (n=40) respectively.In addition,H LA-DR (flow cytometry),as well as of sTREM-1 (enzyme linked immunosorbent assay ),acute physiology and chronic health evaluation Ⅱ ( APACHE Ⅱ ) score,hospital days,the ICU length,hospital costs and 28 day mortality were reco4rded.Results Compared with non-increased estradiol group,HLA-DR in increased estradiol group decreased significantly [(61.22 ± 22.39)％ vs. (75.09 ± 14.85)％],while sTREM-1 (ng/L) increased obviously (291.59 ± 148.13 vs.216.48 ± 124.82 ),APACHE Ⅱ score lowered dramatically ( 11.47 ± 6.88 vs.15.36 ± 8.79),hospital costs (ten thousands) raised significantly ( 10.98 ± 8.15 vs 6.25 ± 3.51 ),ICU length (days) was much shorter ( 8.56 ± 4.05 vs.12.17 ± 7.99 ),and 28 days mortality was significantly lowered ( 10.00％ vs.32.75％,P＜0.05 or P＜0.01 ).Compared with non-increased prolactin group,increased prolactin group had much lower HLA-DR levels [(61.19 ± 21.50)％ vs. (72.02 ± 18.49)％],higher sTREM-1 levels (307.92 ±173.93 vs.223.01 ± 106.93),at the same time,their cost of hospitalization (7.75 ± 3.52 vs.11.36 ± 8.24) and ICU stay length (9.14 ± 3.15 vs.13.24 ± 2.16) were significantly lower (all P＜0.05 ).Compared with non-decreased testosterone group,HLA-DR in decreased testosterone group increased significantly [(74.69 ± 14.72 )％ vs.(62.24 ±22.54)％ ],while sTREM-1 decreased obviously (208.77 ± 77.80 vs.294.20 ± 169.36),APACHE Ⅱ score lowered dramatically ( 10.57 ± 6.97 vs.15.39 ± 9.46),hospital costs decreased significantly (7.67 ± 3.81 vs.11.19 ± 8.05 ),and 28 days mortality lowered significantly (0 vs.30.14％,P＜0.05 or P＜0.01 ).Conclusion In the early stage of severe intra-abdominal infection,estrogen,prolactin and testosterone levels had powerful influences on immune,inflammation,and orognosis,which may indicated a widespread clinical application.
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