Chéron A, Monneret G, Landelle C, Floccard B, Allaouchiche B
Département d'anesthésie-réanimation, service de réanimation, hôpital Edouard-Herriot, hospices civils de Lyon, pavillon G, place d'Arsonval, 69437 Lyon cedex 03, France.
Ann Fr Anesth Reanim. 2010 May;29(5):368-76. doi: 10.1016/j.annfar.2010.02.015. Epub 2010 Mar 30.
The aim of this bibliographic review is to evaluate the usefulness of the measurement of HLA-DR expression on circulating monocytes (mHLA-DR) in predicting the development of nosocomial infections and unfavourable outcome in critically ill patients.
References obtained from the medical database PubMed in English and in French were reviewed. The keywords included separately or in combination were: HLA-DR antigens, sepsis, trauma, injuries, wounds, burns, stroke, pancreatitis, postoperative, prognostic, immunity, monocytic.
Data in selected articles were reviewed, clinical and basic science research relevant information were extracted.
Low mHLA-DR expression appears as a marker for monocytic dysfunctions and immunosuppression, temporarily present in the majority of critically ill patients admitted to the ICU (sepsis, trauma injuries, postoperative, burns, pancreatitis and stroke). The decrease in mHLA-DR expression is a predictor of septic complications in all these clinical conditions. However, no predictive threshold value could be determined regarding unfavourable outcome.
The monitoring of mHLA-DR expression could be a biomarker to detect ICU patients at high risk of developing secondary nosocomial infections. Those patients could probably benefit of preemptive strategies to prevent these infections.
本文献综述旨在评估循环单核细胞上 HLA - DR 表达（mHLA - DR）的检测在预测重症患者医院感染发生及不良预后方面的实用性。
对从医学数据库 PubMed 中获取的英文和法文参考文献进行了综述。单独或组合使用的关键词有：HLA - DR 抗原、脓毒症、创伤、损伤、伤口、烧伤、中风、胰腺炎、术后、预后、免疫、单核细胞。
对所选文章中的数据进行了综述，提取了临床和基础科学研究的相关信息。
低 mHLA - DR 表达表现为单核细胞功能障碍和免疫抑制的标志物，在入住重症监护病房（ICU）的大多数重症患者（脓毒症、创伤损伤、术后、烧伤、胰腺炎和中风）中暂时存在。在所有这些临床情况下，mHLA - DR 表达降低是脓毒症并发症的预测指标。然而，关于不良预后无法确定预测阈值。
监测 mHLA - DR 表达可能是一种生物标志物，用于检测有发生继发性医院感染高风险的 ICU 患者。这些患者可能会从预防这些感染的抢先策略中获益。
