单核细胞人类白细胞抗原-DR 表达的变化可作为严重脓毒症患者死亡率的可靠预测指标。
Changes of monocyte human leukocyte antigen-DR expression as a reliable predictor of mortality in severe sepsis.
机构信息
Department of Surgical Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Er Road, Guangzhou 510080, PR China.
出版信息
Crit Care. 2011;15(5):R220. doi: 10.1186/cc10457. Epub 2011 Sep 20.
INTRODUCTION
Many studies have shown that monocyte human leukocyte antigen-DR (mHLA-DR) expression may be a good predictor for mortality in severe septic patients. On the contrary, other studies found mHLA-DR was not a useful prognostic marker in severe sepsis. Few studies have taken changes of mHLA-DR during treatment into consideration. The objective of this study was to estimate the prognostic value of changes of mHLA-DR to predict mortality in severe sepsis.
METHODS
In this prospective observational study, mHLA-DR was measured by flow cytometry in peripheral blood from 79 adult patients with severe sepsis. mHLA-DR levels were determined on day 0, 3, 7 after admission to the surgical intensive care unit (SICU) with a diagnosis of severe sepsis. ΔmHLA-DR₃ and ΔmHLA-DR₇ were defined as the changes in mHLA-DR value on day 3 and day 7 compared to that on day 0. Data were compared between 28-day survivors and non-survivors. Receiver operating characteristic (ROC) curves were plotted to measure the performance and discriminating threshold of ΔmHLA-DR₃, ΔmHLA-DR₇, ΔmHLA-DR₇-₃, mHLA-DR₀, mHLA-DR₃ and mHLA-DR₇ in predicting mortality of severe sepsis.
RESULTS
ROC curve analysis showed that ΔmHLA-DR₃ and ΔmHLA-DR7 were reliable indicators of mortality in severe sepsis. A ΔmHLA-DR₃ value of 4.8% allowed discrimination between survivors and non-survivors with a sensitivity of 89.0% and a specificity of 93.7%; similarly, ΔmHLA-DR₇ value of 9% allowed discrimination between survivors and non-survivors with a sensitivity of 85.7% and a specificity of 90.0%. Patients with ΔmHLA-DR₃ ≤ 4.8% had higher mortality than those with ΔmHLA-DR₃ > 4.8% (71.4% vs. 2.0%, OR 125.00, 95% CI 13.93 to 1121.67); patients with ΔmHLA-DR7 ≤ 9% had higher mortality than those with ΔmHLA-DR₇ > 9% (52.9% vs. 2.0%, OR 54.00, 95% CI 5.99 to 486.08). The mean change of mHLA-DR significantly increased in the survivor group with the passage of time; from day 0 to day 3 and day 7, changes were 6.45 and 16.90 (P < 0.05), respectively.
CONCLUSIONS
The change of mHLA-DR over time may be a reliable predictor for mortality in patients with severe sepsis.
介绍
许多研究表明，单核细胞人类白细胞抗原-DR（mHLA-DR）的表达可能是严重脓毒症患者死亡的良好预测指标。相反，其他研究发现 mHLA-DR 并不是严重脓毒症的有用预后标志物。很少有研究考虑 mHLA-DR 在治疗过程中的变化。本研究的目的是评估 mHLA-DR 变化预测严重脓毒症患者死亡率的预后价值。
方法
在这项前瞻性观察研究中，通过流式细胞术测量 79 例成人严重脓毒症患者外周血中的 mHLA-DR。mHLA-DR 水平在入住外科重症监护病房（SICU）后第 0、3、7 天进行测定，诊断为严重脓毒症。定义 mHLA-DR₃ 和 mHLA-DR₇ 的变化为第 3 天和第 7 天与第 0 天相比的 mHLA-DR 值的变化。比较 28 天幸存者和非幸存者之间的数据。绘制受试者工作特征（ROC）曲线，以衡量 ΔmHLA-DR₃、ΔmHLA-DR₇、ΔmHLA-DR₇-₃、mHLA-DR₀、mHLA-DR₃ 和 mHLA-DR₇ 在预测严重脓毒症死亡率方面的表现和区分阈值。
结果
ROC 曲线分析表明，ΔmHLA-DR₃ 和 ΔmHLA-DR7 是严重脓毒症死亡率的可靠指标。ΔmHLA-DR₃ 值为 4.8%可区分幸存者和非幸存者，灵敏度为 89.0%，特异性为 93.7%；同样，ΔmHLA-DR₇ 值为 9%可区分幸存者和非幸存者，灵敏度为 85.7%，特异性为 90.0%。ΔmHLA-DR₃≤4.8%的患者死亡率高于ΔmHLA-DR₃>4.8%的患者（71.4% vs. 2.0%，OR 125.00，95%CI 13.93-1121.67）；ΔmHLA-DR₇≤9%的患者死亡率高于ΔmHLA-DR₇>9%的患者（52.9% vs. 2.0%，OR 54.00，95%CI 5.99-486.08）。随着时间的推移，mHLA-DR 的平均变化在幸存者组中显著增加；从第 0 天到第 3 天和第 7 天，变化分别为 6.45 和 16.90（P<0.05）。
结论
mHLA-DR 的时间变化可能是严重脓毒症患者死亡率的可靠预测指标。
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