摘要
目的 观察重症脓毒症患者外周血单核细胞（PBMC）人类白细胞抗原（HLA-DR）、天然免疫的模式识别受体TIR4（toll like receptor 4）在不同预后的表达变化.方法 选取35例符合重症脓毒症患者为重症脓毒症组和15名健康志愿者作为对照组.35例重症脓毒症患者按预后又分为好转组（25例）与死亡组（10例）,用流式细胞仪检测PBMC表面HLA-DR、TLR4表达.结果 治疗前重症脓毒症组外周血单核细胞数量[（0.39±0.30）×109/L]及其表面HLA-DR（10.25±5.35）FMI、TLR4（10.93±5.66）FMI表达均低于正常对照[（0.62±0.41）×106/L、（59.28±14.76）FMI、（39.86±8.55）FMI]（t=2.423、12.52、14.12,P〈0.01或P〈0.05）.重症脓毒症组经ICU综合治疗后,好转组,随着各项指标好转,单核细胞的数量及其表面HLA-DR、TLR4表达各观察点逐渐呈升高趋势,单核细胞数量[（1.03±0.78）×106/L]、HLA-DR[（25.12±9.29）FMI]及TLR4（36.68±16.61）FMI于第5天恢复正常人水平,与治疗前比较差异均有统计学意义（P〈0.01,〈0.05）.死亡组单核细胞的数量及其表面HLA-DR、TLR4表达各观察点持续在较低水平,各时点比较差异均无统计学意义（P均〉0.05）.结论 重症脓毒症患者外周血单核细胞数量及其表面HLA-DR、TLR4表达可能与患者的免疫状态、预后情况密切相关.
Objective To observe the change of expressions of human leukocyte antigen-DR （HLA-DR） ,pattern recognition receptor TLR4（toll like receptor 4） of peripheral blood mononuclear cell（ PBMC） with severe sepsis and its relation to clinical outcome. Methods Thirty-five patients with severe sepsis and fifteen healthy volunteers were enrolled into this study. Thirty-five patients with severe sepsis were divided into the improved group （re =25） and the death group （n = 10）.The protein expression level of HLA-DR,TLR4 on PBMC was analyzed by flowcytometry. Results The quantity of monocytes（0. 39 ± 0. 30） and the expression level of HLA-DR （10. 25 ± 5. 35）, TLR4 （10. 93 ± 5. 66） on PBMC were significantly lower than those in healthy volunteers （ 0. 62 ± 0.41 ） , （59. 28 ±14. 76） and （39. 86 ±8. 55） pre-treat（P〈0.01or P 〈0. 05）.Along with the clinical condition improved, the quantity of monocytes and the protein expressions of HLA-DR, TLR4 on PBMC were gradually increased at each timepoint in the improved group. In this group the quantity of monocytes （1. 03 ± 0. 78） and TLR4 expression （36. 68 ± 16. 61 ） turned to the normal range in the 5th day, which were significantly higher than pre-treat （P 〈 0. 05 ）. However,the expression failed to return to normal range at each time point in the death groups and there were no significant difference between each time point （ P 〉 0.05）. Conclusions The quantity of monocytes and the expression level of HLA-DR,TLR4 on PBMC show significant relevance to patients＇ imnmnological function and the clinical outcome.
出处
《中国综合临床》
2010年第7期743-745,共3页
Clinical Medicine of China
