浙江临床医学.docVIP

流式细胞术检测外周血单核细胞HLA-DR表达与脓毒症的关系 王兆丰 黄俊军 陈松劲 （浙江省嘉兴市第二医院 314000） [摘要]目的 通过测定单核细胞活化功能来监测脓毒症患者的免疫功能并评价其临床意义。方法 健康体检人群对照组和ICU病房患者（分为A组、B组、C组）用流式细胞术测定外周血HLA-DR+/CD14+、HLA-DR+/CD14+MFI。结果 ICU病房患者与健康体检人群比较外周血HLA-DR+/CD14+、HLA-DR+/CD14+ MFI显著降低（p 0.001）， B组、C组与A组比较HLA-DR+/CD14+降低（p 0. 01）。C组与B组比较HLA-DR+/CD14+降低（p 0. 01）。结论 患者HLA-DR+/CD14+、HLA-DR+/CD14+MFI表达持续低下可提示患者处于免疫麻痹状态，在脓毒症患者中检测细胞因子HLA-DR+/CD14+、HLA-DR+/CD14+MFI表达来监测其免疫功能是一种早期的、可预见的评估脓毒症严重程度和预后的方法。 [关键词] 脓毒症 HLA-DR+/CD14+ 免疫麻痹 流式细胞术 Relation of monocyte HLA-DR in whole blood by flow cytometry with sepsis wang zhao-feng. huang Jun-jun. Chen Song-jin The second hospital of JiaXing，Zhejiang 314000 [Abstract]Objective To monitor of monocyte human leukocyte antigen DR to evaluate the clinical significance in sepsis. Methods measured HLA-DR+/CD14+、HLA-DR+/CD14+ MFI by flow cytometry with the ICU patients and the healthy Results the expression of HLA-DR+/CD14+、HLA-DR+/CD14+ MFI in the ICU patients were lower than that in the healthy（p 0.001）; the expression of HLA-DR+/CD14+ in the grow B and C were lower than that in the grow A（p 0.01）; the expression of HLA-DR+/CD14+ in the grow C were lower than that in the grow B（p 0.01）;Conclusions low level of HLA-DR+/CD14+、HLA-DR+/CD14+ MFI show the patients were in the states of immune paralysis, monitor expression of cytokines HLA-DR+/CD14+、HLA-DR+/CD14+ MFI can be used to evaluate the severity of disease and predict prognosis in sepsis that is a early、foreseeable methods . [key word] Sepsis HLA-DR+/CD14+ Immune paralysis Flow cytometry 细胞因子正成为预测免疫功能的标志，脓毒症（sepsis）是指由感染引发的全身炎症反应综合症。可能并不像以往的“过度炎症反应”，更多的是由于“过度抑制”参与其中，有学者认为在初期炎症反应之后发生的抗炎反应的本质是单核细胞失活所致的免疫功能不全。称之为免疫麻痹。[1] 1.资料与方法： 1.1研究对象及处理：健康体检人群对照组（n=20）。ICU病房患者（包括创伤 烧伤、大手术和胰腺炎等）67例患者。其中男39例，女28例，将其分为A组（非脓毒症）B组（符合脓毒症但未达到严重脓毒症诊断标准）C组（符合严重脓毒症诊断标准）。诊断标准：脓毒症、严重脓毒症、MODS的诊断标准参考美国胸科医师协会（ACCP）和美国危重病医学会联席会议制定的诊断标准。[2] 1.2试剂仪器：流式细胞仪采用美国COULTER-EPICS-XL型四式荧光流式细胞仪。试剂：法国Immunotech公司生产，CD14-FIT