Ono Satoshi, Tsujimoto Hironori, Matsumoto Atsushi, Ikuta Shin-Ichi, Kinoshita Manabu, Mochizuki Hidetaka
Department of Surgery I, National Defense Medical College, Namiki 3-2, Tokorozawa, Saitama 359-8513, Japan.
Am J Surg. 2004 Aug;188(2):150-6. doi: 10.1016/j.amjsurg.2003.12.067.
Hemoperfusion with PMX-F (polymyxin B covalently immobilized on fibers) has been reported to be safe and effective for patients with septic shock. However, the molecular mechanism of this usefulness is not yet clear. The purpose of this study was to evaluate whether the expression of CD14, human leukocyte antigen (HLA)-DR on monocytes, and the expression of CD16, CD11b/CD18 on neutrophils, are altered in septic patients according to the severity, and whether PMX-F treatment affects the clinical parameters and the expression of leukocyte surface antigen expression.
Thirty-four patients who were taken to the National Defense Medical College hospital at emergency, and who had an identified focus of infections, were enrolled in this study. The patients were divided into three groups: non-systemic inflammatory response syndrome [SIRS]) group, sepsis group, and septic shock group. Peripheral blood samples were collected at the time of admission to our hospital. The CD14, HLA-DR expression on monocytes and the CD11b/CD18, CD16 expression on granulocytes were evaluated using flowcytometry, and the serum interleukin (IL)-6 and IL-10 levels were measured using enzyme-linked immunosorbent assay. Treatment with a PMX-F column was performed in 10 patients with septic shock.
The HLA-DR expression on monocytes and the CD16 intensity on granulocytes in patients with septic shock were significantly lower than those in patients with sepsis. The serum IL-6 and 10 levels in patients with septic shock were significantly higher than those in patients with sepsis. The mean systolic blood pressure in patients with septic shock was significantly increased after the PMX-F treatment; furthermore, the HLA-DR expression on monocytes and the CD16 intensity on granulocytes were significantly increased after the PMX-F treatment. The serum IL-10 levels were significantly decreased after the PMX-F treatment.
We showed that the surface antigens, HLA-DR on monocytes and CD16 on granulocytes, are extremely decreased in patients with septic shock, and that PMX-F treatment is effective for beneficially increasing the surface antigen expression on leukocytes. This therapy might be a new strategy for helping patients recover from immunoparalysis in septic conditions.
据报道，使用PMX-F（共价固定在纤维上的多粘菌素B）进行血液灌流对感染性休克患者是安全有效的。然而，这种有效性的分子机制尚不清楚。本研究的目的是评估根据严重程度，脓毒症患者单核细胞上CD14、人类白细胞抗原（HLA）-DR的表达以及中性粒细胞上CD16、CD11b/CD18的表达是否发生改变，以及PMX-F治疗是否会影响临床参数和白细胞表面抗原表达。
34名因急诊被送往国防医学院医院且有明确感染源的患者纳入本研究。患者分为三组：非全身炎症反应综合征（SIRS）组、脓毒症组和感染性休克组。入院时采集外周血样本。使用流式细胞术评估单核细胞上CD14、HLA-DR的表达以及粒细胞上CD11b/CD18、CD16的表达，并使用酶联免疫吸附测定法测量血清白细胞介素（IL）-6和IL-10水平。对10名感染性休克患者进行PMX-F柱治疗。
感染性休克患者单核细胞上的HLA-DR表达和粒细胞上的CD16强度显著低于脓毒症患者。感染性休克患者的血清IL-6和IL-10水平显著高于脓毒症患者。PMX-F治疗后，感染性休克患者的平均收缩压显著升高；此外，PMX-F治疗后单核细胞上的HLA-DR表达和粒细胞上的CD16强度显著增加。PMX-F治疗后血清IL-10水平显著降低。
我们发现，感染性休克患者单核细胞上的表面抗原HLA-DR和粒细胞上的CD16极度降低，且PMX-F治疗可有效有益地增加白细胞表面抗原表达。这种治疗方法可能是帮助脓毒症患者从免疫麻痹中恢复的一种新策略。
