CAJ | 학술논문

目的探讨老年脓毒症患者血清甲状腺素水平与单核细胞人白细胞抗原DR(HLA-DR)表达的变化,并评价其临床意义.方法 125例住院的老年脓毒症非甲状腺疾病患者按照2001年国际脓毒症定义讨论公报分为非重症脓毒症组(在后面均简称脓毒症组,n=86)、重症脓毒症组(n=39),另设30例老年健康体检者为对照组;用化学发光法检测患者的血清甲状腺素水平,同时用流式细胞仪检测患者外周血单个核细胞(PBMC)表面HLA-DR分子的表达,比较各组之间的差别.结果与对照组及脓毒症组比较,重症脓毒症组的三碘甲状腺原氨酸(T_3)、四碘甲状腺原氨酸(T_4)、游离三碘甲状腺原氨酸(FT_3)、游离四碘甲状腺原氨酸(FT_4)水平均明显减低(P<0.05),促甲状腺素(TSH)无显著变化(P>0.05),HLA-DR表达显著减低(P<0.05);与对照组比较,脓毒症组T_3、T_4、FT_3、FT_4、TSH水平也明显减低(P<0.05),HLA-DR也显著减低(P<0.05);其中重症脓毒症死亡组(放弃治疗或死亡)T_3、T_4、FT_3、FT_4水平及HLA-DR的表达明显低于存活组(转入普通病房)(P<0.05).结论老年脓毒症患者随脓毒症病情的加重,血清甲状腺素水平与HLA-DR表达的变化呈明显下降趋势,联合二者可较好反映脓毒症的严重程度及预后.
목적 탐토노년농독증환자혈청갑상선소수평여단핵세포인백세포항원DR(HLA-DR)표체적변화,병평개기림상의의.방법 125례주원적노년농독증비갑상선질병환자안조2001년국제농독증정의토론공보분위비중증농독증조(재후면균간칭농독증조,n=86)、중증농독증조(n=39),령설30례노년건강체검자위대조조;용화학발광법검측환자적혈청갑상선소수평,동시용류식세포의검측환자외주혈단개핵세포(PBMC)표면HLA-DR분자적표체,비교각조지간적차별.결과 여대조조급농독증조비교,중증농독증조적삼전갑상선원안산(T_3)、사전갑상선원안산(T_4)、유리삼전갑상선원안산(FT_3)、유리사전갑상선원안산(FT_4)수평균명현감저(P<0.05),촉갑상선소(TSH)무현저변화(P>0.05),HLA-DR표체현저감저(P<0.05);여대조조비교,농독증조T_3、T_4、FT_3、FT_4、TSH수평야명현감저(P<0.05),HLA-DR야현저감저(P<0.05);기중중증농독증사망조(방기치료혹사망)T_3、T_4、FT_3、FT_4수평급HLA-DR적표체명현저우존활조(전입보통병방)(P<0.05).결론 노년농독증환자수농독증병정적가중,혈청갑상선소수평여HLA-DR표체적변화정명현하강추세,연합이자가교호반영농독증적엄중정도급예후.
Objective To investigate the changes of thyroxin and monoeyte human leukocyte antigen-DR expression in senior patients with sepsis and explore their clinical significance. Methods According to the 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions, 125 senior patients with sepsis free of thyroid conditions were divided into non-severe sepsis group (n=86) and severe sepsis group (n=39), with another 30 healthy subjects as the control. Thyroid function was assayed by chemoluminescence method in these patients and monocyte HLA-DR expression was determined by flow cytometry. Results Compared with the control group and non-severe sepsis cases, the levels of free T3 (FT3), free T4 (FT4), T3, T4 and monocyte HLA-DR expression were significantly lower in severe sepsis eases (P<0.05), but the levels of thyroid stimulating hormone (TSH) were comparable between the 3 groups (/9>0.05). The non-severe sepsis cases showed significantly lower levels of FT3, FT4, T3, T4, TSH and monocyte HLA-DR expression than the control group (P<0.05). In severe sepsis group, the levels of FT3, FT4, T3, T4 and monocyte HLA-DR expression showed significant differences between the fatal cases and surviving cases (P<0.05). Conclusion The levels of thyroxin and monocyte human leukocyte antigen-DR expression are obviously lower in senior patients with severe sepsis, and their detection may well indicate the severity of the condition and help make prognostic judgment.