From the Intensive Care and Department of Pediatric Surgery.
Department of Pediatrics, Division of Pediatric Infectious Diseases & Immunology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Pediatr Infect Dis J. 2018 Oct;37(10):1034-1040. doi: 10.1097/INF.0000000000001990.
To longitudinally study blood monocyte subset distribution and human leukocyte antigen-DR (HLA-DR) expression on monocyte subsets in children with sepsis, post-surgery and trauma in relation to nosocomial infections and mortality.
In 37 healthy children and 37 critically ill children (12 sepsis, 11 post-surgery, 10 trauma and 4 admitted for other reasons)-participating in a randomized controlled trial on early versus late initiation of parenteral nutrition-monocyte subset distribution and HLA-DR expression on monocyte subsets were measured by flow cytometry upon admission and on days 2, 3 and 4 of pediatric intensive care unit (PICU) stay.
Upon PICU admission, critically ill children had a higher proportion of classical monocytes (CD14++CD16-) than healthy children [PICU 95% (interquartile range [IQR] 88%-98%); controls, 87% (IQR 85%-90%), P < 0.001]. HLA-DR expression was significantly decreased within all monocyte subsets and at all time points, being most manifest on classical monocytes and in patients with sepsis. Percentage of HLA-DR expressing classical monocytes [upon PICU admission 67% (IQR 44%-88%); controls 95% (IQR 92%-98%), P < 0.001], as well as the HLA-DR mean fluorescence intensity [upon PICU admission 3219 (IQR 2650-4211); controls 6545 (IQR 5558-7647), P < 0.001], decreased during PICU stay. Patients who developed nosocomial infections (n = 13) or who died (n = 6) had lower HLA-DR expression on classical monocytes at day 2 (P = 0.002) and day 3 (P = 0.04), respectively.
Monocytic HLA-DR expression decreased during PICU stay and was lower compared with controls on all examined time points, especially on classical monocytes and in children admitted for sepsis. Low HLA-DR expression on classical monocytes was associated with nosocomial infections and death.
为了纵向研究败血症、手术后和创伤后儿童血液单核细胞亚群分布和单核细胞亚群上人类白细胞抗原-DR（HLA-DR）的表达与医院感染和死亡率的关系。
在 37 名健康儿童和 37 名危重病儿童（12 例败血症，11 例手术后，10 例创伤，4 例因其他原因入院）中，对接受早期与晚期肠外营养起始的随机对照试验进行了研究-通过流式细胞术测量单核细胞亚群的分布和单核细胞亚群上 HLA-DR 的表达，在儿科重症监护病房（PICU）住院的第 1 天和第 2、3、4 天。
在 PICU 入院时，危重病儿童的经典单核细胞（CD14++CD16-）比例高于健康儿童[PICU 95%（四分位距[IQR] 88%-98%）；对照组，87%（IQR 85%-90%），P <0.001]。在所有单核细胞亚群和所有时间点，HLA-DR 的表达均显著降低，在经典单核细胞和败血症患者中最为明显。HLA-DR 表达的经典单核细胞比例[PICU 入院时 67%（IQR 44%-88%）；对照组 95%（IQR 92%-98%），P <0.001]，以及 HLA-DR 平均荧光强度[PICU 入院时 3219（IQR 2650-4211）；对照组 6545（IQR 5558-7647），P <0.001]，在 PICU 住院期间下降。发生医院感染（n = 13）或死亡（n = 6）的患者，在第 2 天（P = 0.002）和第 3 天（P = 0.04）时经典单核细胞上的 HLA-DR 表达较低。
在 PICU 住院期间，单核细胞 HLA-DR 的表达下降，与对照组相比，所有检查时间点均较低，尤其是经典单核细胞和败血症患儿。经典单核细胞上低 HLA-DR 表达与医院感染和死亡相关。
