CAJ | 학술논문

目的：观察严重创伤患者早期CD14阳性单核细胞HLA－DR表达率（ HLA－DR CD14＋％）的变化规律，并探讨HLA－DR CD14＋％与严重创伤的预后关系及意义。方法回顾性分析2010－06～2012－12在广州军区广州总医院急危重症救治中心住院的严重创伤患者（ AIS－ISS评分≥16分）共79例，生存组（ n＝54）和死亡组（ n＝25），分析两组患者伤后年龄、性别构成、AIS－ISS评分、APACHEⅡ评分、GCS评分、致伤因素、受伤部位、血清降钙素原（ PCT ）和HLA－DR CD14＋％、接受损伤控制性手术例数和免疫调理等方面的差别，观察并分析患者伤后第3、7天的APACHEⅡ评分和HLA－DR CD14＋％的变化以及二者的相关性，采用ROC曲线及回归分析评估HLA－DR CD14＋％对严重创伤患者死亡的预判价值。结果两组患者入院情况分析比较差异无统计学意义（P＞0．05），所有患者APACHEⅡ和HLA－DR CD14＋％变化具有统计学意义（ P＜0．05）。与对照组比较，死亡组HLA－DR CD14＋％在第3天开始出现下降（ P＜0.05），而死亡组APACHEⅡ在第7天才高于存活组（ P＜0．05）。以第3天HLA－DR CD14＋％值对于严重创伤患者死亡预判差异有统计学意义（P＜0．05），其ROC曲线下总面积为0．894。多因素回归分析严重创伤患者第3天HLA－DR CD14＋％值是预判死亡的危险因素。结论 HLA－DR CD14＋％是预判严重创伤患者预后的可靠指标，受伤后第3天HLA－DR CD14＋％水平是预测严重创伤患者死亡的危险因素。
목적：관찰엄중창상환자조기CD14양성단핵세포HLA－DR표체솔（ HLA－DR CD14＋％）적변화규률，병탐토HLA－DR CD14＋％여엄중창상적예후관계급의의。방법회고성분석2010－06～2012－12재엄주군구엄주총의원급위중증구치중심주원적엄중창상환자（ AIS－ISS평분≥16분）공79례，생존조（ n＝54）화사망조（ n＝25），분석량조환자상후년령、성별구성、AIS－ISS평분、APACHEⅡ평분、GCS평분、치상인소、수상부위、혈청강개소원（ PCT ）화HLA－DR CD14＋％、접수손상공제성수술례수화면역조리등방면적차별，관찰병분석환자상후제3、7천적APACHEⅡ평분화HLA－DR CD14＋％적변화이급이자적상관성，채용ROC곡선급회귀분석평고HLA－DR CD14＋％대엄중창상환자사망적예판개치。결과량조환자입원정황분석비교차이무통계학의의（P＞0．05），소유환자APACHEⅡ화HLA－DR CD14＋％변화구유통계학의의（ P＜0．05）。여대조조비교，사망조HLA－DR CD14＋％재제3천개시출현하강（ P＜0.05），이사망조APACHEⅡ재제7천재고우존활조（ P＜0．05）。이제3천HLA－DR CD14＋％치대우엄중창상환자사망예판차이유통계학의의（P＜0．05），기ROC곡선하총면적위0．894。다인소회귀분석엄중창상환자제3천HLA－DR CD14＋％치시예판사망적위험인소。결론 HLA－DR CD14＋％시예판엄중창상환자예후적가고지표，수상후제3천HLA－DR CD14＋％수평시예측엄중창상환자사망적위험인소。
Objective To investigate the variation of HLA -DR expression on CD14 positive monocytes ( HLA-DR CD14 +%) and the importance of HLA -DR CD14 +%using for the prognosis of patients with major trauma .Methods Seventy -nine patients with major trauma who admitted in the emergency and critical care center in General Hospital of Guangzhou Military Command from Jun , 2010 to Dec, 2012 were divided into survivor group ( n =54 ) and non -survivor group ( n =25 ) .The differences between two groups on age , gender, AIS -ISS scores, APACHEⅡscores, GCS scores, wound agent, injury portion, the members accepted emergency operation and immunotherapy , the level of procalcitonin (PCT) and HLA-DR CD14 +%were analyzed.The pattern of APACHEⅡand HLA-DR CD14 +%level were observed from 3rd to 7th day following the injury.ROC program and regression analysis were performed to evaluate the value of HLA -DR CD14 +% for the prognosis of patients with major trauma.Results There was no difference on the baseline between two groups (P>0.05).A significant correlation was found between APACHEⅡand HLA-DR CD14 +% level in these patients after the injury (P<0.05).However, the level of HLA-DR CD14 +% on 3rd day in non-survivor group was observed to decrease in comparison with the level in survivor group .And the value of APACHEⅡin non-survivor group presented to increase in comparison with the value in survivor group until 7th days.On 3rd day, the level of HLA-DR CD14 +%was statistically valuable to the outcome. The AUC in ROC program for predictive value of HLA -DR CD14 +% on 3rd day was 0.894. Moreover, the lower level of HLA -DR CD14 +%on 3rd day was a hazard risk for death by multivariate regression analysis . Conclusion The level of HLA -DR CD14 +% was reliably applied to the prognosis of the patients with major trauma .On 3rd day after injury , the lower value of HLA -DR CD14 +%was a hazard risk for death.