Satoh Akihiko, Miura Toshihiko, Satoh Kennichi, Masamune Atsushi, Yamagiwa Tetsuya, Sakai Yoshitaka, Shibuya Kazuhiko, Takeda Kazunori, Kaku Mitsuo, Shimosegawa Tooru
Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Pancreas. 2002 Oct;25(3):245-50. doi: 10.1097/00006676-200210000-00006.
The mortality associated with severe acute pancreatitis is still high, and death in the later stage of the disease is chiefly due to bacterial infection and sepsis. However, objective parameters for the risk of sepsis in acute pancreatitis have not been established.
To investigate the value of human leukocyte antigen-DR (HLA-DR) on peripheral monocytes for predicting the development of sepsis during acute pancreatitis.
The expression of HLA-DR on peripheral monocytes was measured in 64 patients by flow cytometry at admission and 7 and 14 days after the onset of acute pancreatitis. Twenty-eight patients with severe acute pancreatitis and 36 with mild acute pancreatitis, as determined by the Atlanta classification, were enrolled.
Six patients had sepsis, and two of them died during the hospital stay. At admission, the percentage of HLA-DR-expressing cells in the monocyte population was significantly lower in the patients who had sepsis in the later course than in the patients who did not have sepsis. A percentage lower than 80% at admission was observed in 17 patients, and the patients who had persistently low percentages of HLA-DR-expressing monocytes throughout the observation period had sepsis in the later clinical course, whereas the patients in whom expression recovered to the normal range were spared the development of sepsis.
In acute pancreatitis, the low percentage of HLA-DR-expressing cells in the monocyte population is a reliable predictor of the development of sepsis. Monitoring of monocyte HLA-DR expression may be a useful marker for identifying the patients who are at high risk of sepsis in acute pancreatitis.
重症急性胰腺炎相关的死亡率仍然很高，疾病后期的死亡主要归因于细菌感染和脓毒症。然而，急性胰腺炎中脓毒症风险的客观参数尚未确立。
探讨外周血单核细胞上人类白细胞抗原-DR（HLA-DR）对预测急性胰腺炎期间脓毒症发生的价值。
通过流式细胞术对64例患者在入院时以及急性胰腺炎发病后7天和14天测量外周血单核细胞上HLA-DR的表达。纳入根据亚特兰大分类法确定的28例重症急性胰腺炎患者和36例轻症急性胰腺炎患者。
6例患者发生脓毒症，其中2例在住院期间死亡。入院时，后期发生脓毒症的患者单核细胞群体中表达HLA-DR的细胞百分比显著低于未发生脓毒症的患者。17例患者入院时该百分比低于80%，在整个观察期内表达HLA-DR的单核细胞百分比持续较低的患者在后期临床过程中发生了脓毒症，而表达恢复到正常范围的患者未发生脓毒症。
在急性胰腺炎中，单核细胞群体中表达HLA-DR的细胞百分比低是脓毒症发生的可靠预测指标。监测单核细胞HLA-DR表达可能是识别急性胰腺炎中脓毒症高危患者的有用标志物。
