Value of mHLA-DR on the assessment of prognosis in patients with severe pneumonia
ZHOU Shu-jun1, ZHOU Jun2, WANG Da-ming1
(1.Department of Critical Care Medicine, 2.Department of Respiratory Medicine, the Third Affiliated Hospital of SooChow University, Changzhou Jiangsu 213003, China)
摘要目的：探讨监测CD14+单核细胞人白血病抗原DR(monocyte human leukocyte antigen-DR,mHLA-DR)表达在评估重症肺炎患者预后中的价值。方法：挑选38例重症肺炎患者,以明确诊断后28天的预后作为标准分成生存组(22例)与死亡组(16例),另选择38例健康者纳入对照组。在重症肺炎确诊后第1、3、5、7天,应用流式细胞术连续监测患者外周血mHLA-DR的表达;对照组在研究期间常规检测1次mHLA-DR表达。结果：重症肺炎患者确诊后第1天,生存组与死亡组mHLA-DR表达均明显低于对照组(P<0.05)。生存组mHLA-DR表达呈逐渐升高趋势,到第7天生存组mHLA-DR表达已接近对照组水平,两者差异已无统计学意义(P>0.05);而死亡组mHLA-DR表达持续偏低,在各个时间点始终低于对照组,差异均有统计学意义(P<0.05)。相同时间点死亡组mHLA-DR表达均低于生存组,差异均有统计学意义(P<0.05)。以确诊第1天mHLA-DR表达<30％预测重症肺炎患者死亡的敏感度为93.8％,特异度为81.8％。结论：重症肺炎患者确诊后第1天mHLA-DR表达<30％可作为预测患者预后不佳的指标,另外连续监测病程中不同时间点的mHLA-DR表达对重症肺炎患者预后的评估也有一定的价值。
Abstract：Objective: To explore the value of monitoring the CD14+ monocyte human leukocyte antigen-DR （mHLA-DR) expression in patients with severe pneumonia. Methods：A total of 38 cases patients with severe pneumonia were selected and they were divided into survival group(22 cases) and death group(16 cases) according to the prognosis within the 28 day period following the definite diagnosis of severe pneumonia. In addition, 38 healthy subjects were considered as control group.The mHLA-DR expression of three groups was respectively measured by using flow cytometry. The mHLA-DR expression in patients with severe pneumonia was measured on the 1st,3rd,5th,7th day after the definite diagnosis and the mHLA-DR expression of the control group was measured only once during the study. Results：The mHLA-DR expression of death group as well as survival group on the 1st day was lower than that of control group(P<0.05).The mHLA-DR expression of survival group had an increasing trend and was close to that of control group on the 7thday(P>0.05);but the mHLA-DR expression of death group remained low and was lower than that of control group all the time (P<0.05).The mHLA-DR expression of survival group was higher than that of death group in the same time(P<0.05). Taking the 1st day monocytes HLA-DR expression<30％ as a predictor of death, its sensitivity was 93.8％ and specificity was 81.8％. Conclusion：The 1st day mHLA-DR expression<30％ can be used as a predictive index of poor prognosis in patients with severe pneumonia.It is useful to continuously monitor the mHLADR expression for evaluating the prognosis in the patients with severe pneumonia.
周曙俊1，周军2，王大明1. 单核细胞人白细胞抗原DR监测在重症肺炎患者预后评估中的价值[J]. 江苏大学学报:医学版, 2013, 23(1): 30-33.
ZHOU Shu-jun1, ZHOU Jun2, WANG Da-ming1. Value of mHLA-DR on the assessment of prognosis in patients with severe pneumonia. Journal of Jiangsu University(Medicine Edition), 2013, 23(1): 30-33.
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2013, Vol. 23 
