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目的探讨严重烧伤患者人白细胞抗原 DR(HLA-DR)定量表达的变化规律及其临床意义。方法采集77例烧伤大于体表总面积30%的患者的血样,通过流式细胞技术对患者烧伤后不同时段 CD14~+单核细胞表面 HLA-DR 结合量进行动态的定量分析。结果严重烧伤患者伤后第1天开始 CD14~+单核细胞表面 HLA-DR 结合量明显低于正常对照组(P<0.05),其表达均值与烧伤面积呈显著负相关(r=-0.7232,P<0.05)。并发多脏器功能障碍综合征(MODS)者其 CD14~+单核细胞表面的 HLA-DR 表达量持续下降,其巾伤后第3、14、21、28天显著低于非 MODS 组(P<0.05)。随着 CD14~+单核细胞 HLA-DR 表达水平的下降,MODS 发生频率增加,患者预后不良。结论大面积烧伤可导致机体 CD14~+单核细胞 HLA-DR 表达严重受损和免疫功能障碍,动态观察其表达水平有助于烧伤后 MODS 的病程监测及患者预后判断。
Objective To investigate the variation of human leukocyte antigen DR (HLA-DR) expression in patients with severe burns and its clinical significance. Methods Totally 77 blood samples were collected from patients with a burn greater than 30% of the total body surface area. The dynamic quantitative analysis of HLA-DR binding on CD14 + monocytes was performed by flow cytometry. Results The level of HLA-DR binding on the surface of CD14 ~ + monocytes in the severely burned patients was significantly lower than that in the normal control group (P <0.05), and the mean value of the expression was negatively correlated with the burn area (r = -0.7232, P <0.05). The expression of HLA-DR on the surface of CD14 ~ + monocytes in patients with multiple organ dysfunction syndrome (MODS) continued to decline, which were significantly lower than those in non-MODS patients on the 3rd, 14th, 21st and 28th day <0.05). With the decline of HLA-DR expression of CD14 ~ + monocytes, the frequency of MODS increased, and the prognosis of patients was poor. Conclusion Large-area burn can lead to severe impairment of HLA-DR expression and immune dysfunction in CD14 + monocytes. The dynamic observation of the expression of HLA-DR can be helpful to monitor the course of MODS after burn and prognosis.