摘要
目的探讨急性呼吸窘迫综合征(ARDS)患者单核细胞人类白细胞抗原DR(HLA-DR)表达及其与预后的关系。方法2004年7月至2005年6月收住东南大学附属中大医院ICU的76例ARDS患者纳入观察。ARDS确诊当天(第1天)及确诊后第7天抽取外周血,应用流式细胞仪检测T淋巴细胞亚群占淋巴细胞百分比、单核细胞HLA-DR表达以及淋巴细胞凋亡。记录患者年龄、性别、导致ARDS的原因,及ARDS确诊当天急性生理和慢性健康(APACHE)Ⅱ评分、心率、呼吸频率、平均动脉压、氧合指数、动脉血pH、动脉血乳酸、外周血血红蛋白浓度、血小板和白细胞计数以及器官功能衰竭个数。以住院28d病死率为预后判定标准。结果与生存组比较,死亡组患者在ARDS第1天和第7天的单核细胞HLA-DR表达均无明显差异。死亡组患者ARDS第7天的单核细胞HLA-DR表达明显低于ARDS第1天。ARDS第1天HLA-DR≤30%的患者生存时间明显低于HLA-DR>30%患者。ARDS第1天HLA-DR≤30%的患者的28d病死率为67%,有高于HLA-DR>30%患者(42%)的趋势,但差异无统计学意义。以ARDS第1天HLA-DR≤30%作为判断患者死亡指标,其灵敏度为97%,但特异度仅为17%。以ARDS第1天单核细胞HLA-DR表达判断患者预后的ROC曲线下面积为0.553(P=0.618),以患者第1天和第7天单核细胞HLA-DR表达变化判断预后的ROC曲线下面积为0.830(P<0.01)。患者ARDS第1天及第7天HLA-DR表达与APACHEⅡ评分和器官功能衰竭数均无相关性。严重感染导致的ARDS患者的生存时间明显低于其他原因导致的ARDS患者。结论单核细胞HLA-DR≤30%可提示ARDS患者预后不良,HLA-DR表达动态下降对预后判断也具有一定价值。
Objective To investigate the relationship between monocyte human leukocyte antigen-DR （HLA- DR） expression on peripheral monocytes and the prognosis in patients with acute respiratory distress syndrome （ARDS）. Methods Seventy-six patients with ARDS admitted to this hospital between July 2004 and June 2005 were included in this study. After the diagnosis of ARDS, monocytes HLA-DR expression and immunophenotype of lymphocyte （CD3, CD4, CD8） were measured on the 1^st and the 7th days of ARDS using flow cytometry. On the 1^st day of ARDS, the following variables were recorded： age, sex, Acute Physiology and Chronic Health Evaluation （A- PACHE） Ⅱ score, heart rate, respiratory rate, mean arterial pressure, PaO2/FiO2, arterial blood pH and lactate, peripheral blood haemoglobin, platelet and,leukocyte counts and the number of organs with function failure. The pa- t tients were divided into survivors and non-survivors according to whether they died within the 28 day period following the onset of ADRS. Results The monocyte HLA-DR expression on the 1^st and the 7^th days of ARDS were not different between survivors and non-survivors. In the non-survivors, the monocyte HLA-DR expression on the 7^th day of ARDS was significantly lower than that on the 1^st day. The survival time in patients with the 1^st day HLA-DR〉30% was much longer than that in patients with the 1^st day HLA-DR ≤ 30G. The 28 day mortality of patients with the 1^st day HLA-DR ≤30G was 6%, which was slightly higher than that of patients with the 1^st day HLA DR 〉30% （42%）. Taking the 1^st day monocytes HI.A-DR expression ≤30% as a predictor of death, its sensitivity was 97% and specificity was 17%. The area under ROC curve which predicted prognosis using 1^st day HLA-DR was only 0. 553 （P = 0. 618）, while the area under ROC curve which predicted prognosis using the changes of HLA DR expression on the 1^st day and the 7^th day was 0. 830 （P 〈 0.01）. No correlation was found between expression of HLA DR on 1^st day and 7^th day and APACHE Ⅱ score or number of organs with function failure. The survival time of severe inlet tion-induced ARDS patients were lower than that of nowinfection induced ARDS patients. Conclusion Monocyte HLA-DR expression ≤ 30% points to poor prognosis. The decline of HLA-DR expression may be a useful prognostic marker of outcome.
出处
《中华老年多器官疾病杂志》
2009年第2期127-132,共6页
Chinese Journal of Multiple Organ Diseases in the Elderly
基金
江苏省科技发展计划(BS2007048)
江苏省医学领军人才基金(苏卫科教[2006]50号)
作者简介
刘玲，女，1977年11月生，在读博士研究生，主治医师
通讯作者：邱海波，E—mail：haiboq2000@yahoo．com．cn，Tel：025—83272200
