脓毒症中炎症和 CD14/CD16/CD45 巡逻单核细胞的增加：与最终结局的相关性。
Increases in inflammatory and CD14/CD16/CD45 patrolling monocytes in sepsis: correlation with final outcome.
机构信息
4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, ATTIKON University hospital, 1 Rimini Street, 12462, Athens, Greece.
2nd Department of Critical Care Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
出版信息
Crit Care. 2018 Mar 3;22(1):56. doi: 10.1186/s13054-018-1977-1.
BACKGROUND
Evidence on the changes in the absolute counts of monocyte subpopulations in sepsis is missing.
METHODS
Firstly, absolute counts of circulating CD14/HLA-DR/CD45 monocytes were measured by flow cytometry in 70 patients with Gram-negative sepsis and in 10 healthy volunteers. In the second phase, immunophenotyping was performed and the absolute count of circulating inflammatory monocytes and of circulating CD14/CD16/CD45 patrolling monocytes were measured in another 55 patients and 10 healthy volunteers. Measurements were repeated on days 3, 7, and 10. Results were correlated with survival after 28 days.
RESULTS
Greater numbers of CD14/HLA-DR/CD45 monocytes were found on day 1 in survivors compared to nonsurvivors (p = 0.030). Receiver operating characteristic (ROC) analysis showed that a cutoff higher than 337 cells/mm on day 1 could discriminate between survivors and nonsurvivors with a positive predictive value (PPV) of 91.1%. Logistic regression including Sequential Organ Failure Assessment (SOFA) score and Acute Physiology and Chronic Health Evaluation (APACHE) II score showed that an absolute count greater than 337 cells/mm was independently associated with unfavorable outcome (odds ratio (OR) 0.19, p = 0.050). The absolute counts of inflammatory and of CD14/CD16/CD45 monocytes were greater in patients than healthy controls during the entire 10 days of follow-up. The absolute counts on day 3 of CD14/CD16/CD45 monocytes were greater in survivors than nonsurvivors (p = 0.027). ROC analysis revealed that the cutoff at 27 cells/mm could discriminate between survivors and nonsurvivors with PPV of 94.1%. Logistic regression including age, SOFA score, and APACHE II score showed that an absolute count greater than 27 cells/mm was independently associated with unfavorable outcome (OR 0.06, p = 0.033). Logistic regression analysis showed that intra-abdominal infection on day 1 was predictive of low CD14/ CD16/CD45 count on day 3.
CONCLUSION
Circulating counts of inflammatory and patrolling monocytes are greatly increased in Gram-negative sepsis. Absolute counts of CD14/HLA-DR/CD45 monocytes on day 1 and CD14/CD16/CD45 monocytes on day 3 are independently associated with final outcome.
TRIAL REGISTRATION
ClinicalTrials.gov, NCT01223690 . Registered retrospectively on 18 October 2010.
背景
关于革兰氏阴性脓毒症中单核细胞亚群绝对计数变化的证据尚缺乏。
方法
首先，通过流式细胞术测量 70 例革兰氏阴性脓毒症患者和 10 例健康志愿者循环 CD14/HLA-DR/CD45 单核细胞的绝对计数。在第二阶段，进行免疫表型分析，并在另外 55 例患者和 10 例健康志愿者中测量循环炎症性单核细胞和循环 CD14/CD16/CD45 巡逻单核细胞的绝对计数。在第 3、7 和 10 天重复测量。结果与 28 天后的生存情况相关。
结果
与非幸存者相比，幸存者第 1 天的 CD14/HLA-DR/CD45 单核细胞数量更多（p=0.030）。受试者工作特征（ROC）分析显示，第 1 天的截点高于 337 个细胞/mm 可以区分幸存者和非幸存者，阳性预测值（PPV）为 91.1%。包括序贯器官衰竭评估（SOFA）评分和急性生理学和慢性健康评估（APACHE）Ⅱ评分的逻辑回归显示，高于 337 个细胞/mm 的绝对计数与不良结局独立相关（比值比（OR）0.19，p=0.050）。在整个 10 天的随访期间，患者的炎症细胞和 CD14/CD16/CD45 单核细胞绝对计数均高于健康对照组。与非幸存者相比，幸存者第 3 天的 CD14/CD16/CD45 单核细胞绝对计数更高（p=0.027）。ROC 分析显示，截点为 27 个细胞/mm 时，PPV 为 94.1%，可以区分幸存者和非幸存者。包括年龄、SOFA 评分和 APACHE Ⅱ评分的逻辑回归显示，高于 27 个细胞/mm 的绝对计数与不良结局独立相关（OR 0.06，p=0.033）。逻辑回归分析显示，第 1 天的腹腔内感染与第 3 天的低 CD14/CD16/CD45 计数相关。
结论
革兰氏阴性脓毒症中循环炎症细胞和巡逻单核细胞的绝对计数显著增加。第 1 天的 CD14/HLA-DR/CD45 单核细胞和第 3 天的 CD14/CD16/CD45 单核细胞的绝对计数与最终结局独立相关。
试验注册
ClinicalTrials.gov，NCT01223690。于 2010 年 10 月 18 日回顾性注册。
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