Hospices Civils de Lyon, Immunology Laboratory, Hôpital E, Herriot, 5 place d'Arsonval, 69437 Lyon cedex 03, France.
Crit Care. 2011;15(5):231. doi: 10.1186/cc10333. Epub 2011 Oct 7.
Septic syndromes represent a major healthcare problem worldwide. Clinical and experimental evidence indicates that septic patients rapidly present with numerous compromised immune functions. Although flow cytometry remains a relatively confidential diagnostic tool, it could be useful at every step of ICU patient management. Indeed, neutrophil CD64 expression is a sensitive and specific tool for diagnosis of sepsis in adults, neonates and children. Diminished monocyte HLA-DR expression is a reliable marker for the development of monocyte anergy, prediction of secondary nosocomial infection and death in critically ill patients. Finally, the measurement of an increased CD4⁺CD25⁺CD127low regulatory T-cell percentage may represent a reliable marker for the diagnosis of lymphocyte dysfunctions in these patients. Ideally, these biomarkers should be part of a panel helping to define ICU patients' immune status. The potential of flow cytometry is further illustrated by use of the biomarkers listed above as stratification tools in preliminary clinical studies. Importantly, many other markers of immune dysfunctions are currently under development that could further enable the administration of targeted individualized therapy in ICU patients. The next critical step would be to use these standardized flow cytometry protocols in large multicentric clinical trials testing individualized immunotherapy.
脓毒症综合征是全球范围内一个主要的医疗保健问题。临床和实验证据表明，脓毒症患者迅速出现多种免疫功能受损。虽然流式细胞术仍然是一种相对保密的诊断工具，但它可以在 ICU 患者管理的每一个步骤中都发挥作用。事实上，中性粒细胞 CD64 表达是成人、新生儿和儿童脓毒症诊断的一种敏感和特异的工具。单核细胞 HLA-DR 表达减少是单核细胞无反应、预测重症患者继发医院感染和死亡的可靠标志物。最后，测定增加的 CD4+CD25+CD127low 调节性 T 细胞百分比可能是这些患者淋巴细胞功能障碍诊断的可靠标志物。理想情况下，这些生物标志物应该作为一个帮助确定 ICU 患者免疫状态的面板的一部分。上述生物标志物作为初步临床研究中的分层工具，进一步说明了流式细胞术的潜力。重要的是，目前正在开发许多其他免疫功能障碍的标志物，这可能进一步使 ICU 患者能够接受靶向个体化治疗。下一步的关键是在大型多中心临床试验中使用这些标准化的流式细胞术方案来测试个体化免疫治疗。
