Lin Zi-Qi, Guo Jia, Xia Qing, Yang Xiao-Nan, Huang Wei, Huang Zong-Wen, Xue Ping
Hepatogastroenterology. 2013 Nov-Dec;60(128):1896-902.
BACKGROUND/AIMS: To investigate whether the human leukocyte antigen-DR (HLA-DR) expression on peripheral monocytes can be utilized as a precursor to a secondary infection of severe acute pancreatitis (SAP).
Patients diagnosed with SAP who were admitted into West China Hospital within 48 h after symptom onset from July 1, 2010 to December 31, 2010 (n = 40) were included. HLD-DR expression on peripheral monocytes on the 1st, 3rd, 5th and 7th day of hospitalization was detected with flow cytometry analysis to determine whether a prediction could be made in regards to development of a secondary infection.
There were 11 patients with secondary infection complications, 4 of which died during hospitalization. On the 1st, 3rd, 5th and 7th day, HLA-DR expression on monocytes in the infected patients was lower than those in the noninfected patients (P < 0.05). There was no statistical significance in the serum CRP and APACHE II between the groups on the first day (P > 0.05). Upon initial admission HLA-DR expression showed a negative correlation with longer-term admission APACHE II (r = -0.790, P = 0.000) and serum CRP (r = -0.642, P = 0.000). The area under the ROC curve (AUC) was 0.837 (95%CI: 0.685-0.989, P = 0.001) for admission HLA-DR, 0.809 (95% CI: 0.667-0.951; P = 0.003) for APACHE II score and 0.781 for serum CRP (95% CI: 0.627-0.934; P = 0.007) to predict secondary infection. The cut-off value of prediction of secondary infection was 35.8% in HLA-DR expression with a sensitivity of 81.8% and a specificity of 82.8%, 10.5 in APACHE II on admission with a sensitivity of 90.9% and a specificity of 48.3%, 155 mg/L in serum CRP on admission with a sensitivity of 90.9% and a specificity of 44.8%.
The HLA-DR expression on monocytes may be an ideal marker for an early prediction of secondary infection in SAP.
背景/目的：研究外周血单核细胞上人类白细胞抗原-DR（HLA-DR）的表达是否可作为重症急性胰腺炎（SAP）继发感染的先兆。
纳入2010年7月1日至2010年12月31日症状发作后48小时内入住华西医院的确诊为SAP的患者（n = 40）。采用流式细胞术分析检测住院第1、3、5和7天外周血单核细胞上HLD-DR的表达，以确定是否可对继发感染的发生进行预测。
11例患者出现继发感染并发症，其中4例在住院期间死亡。在第1、3、5和7天，感染患者单核细胞上的HLA-DR表达低于未感染患者（P < 0.05）。两组患者第一天的血清CRP和APACHE II评分无统计学意义（P > 0.05）。入院时HLA-DR表达与长期住院APACHE II评分（r = -0.790，P = 0.000）和血清CRP（r = -0.642，P = 0.000）呈负相关。入院时HLA-DR预测继发感染的ROC曲线下面积（AUC）为0.837（95%CI：0.685 - 0.989，P = 0.001），APACHE II评分为0.809（95%CI：0.667 - 0.951；P = 0.003），血清CRP为0.781（95%CI：0.627 - 0.934；P = 0.007）。HLA-DR表达预测继发感染的截断值为35.8%，敏感性为81.8%，特异性为82.8%；入院时APACHE II评分为10.5，敏感性为90.9%，特异性为48.3%；入院时血清CRP为155 mg/L，敏感性为90.9%，特异性为44.8%。
单核细胞上的HLA-DR表达可能是早期预测SAP继发感染的理想标志物。
