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Clinical trial to verify the value of the CD+14 monocyte human leukocyte antigen DR as a marker in evaluating immunosuppression in patients with severe sepsis
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- Author:
- No author available
- Journal Title:
- CHINESE CRITICAL CARE MEDICINE
- Issue:
- 3
- DOI:
- 10.3760/j.issn:1003-0603.2003.03.003
- Key Word:
- 脓毒症;免疫抑制;代偿性抗炎症反应综合征;CD+14单核细胞人类白细胞抗原DR;胸腺5肽;免疫调理
Abstract： 目的:验证CD+14单核细胞人类白细胞抗原-DR(HLA-DR)对于评估严重脓毒症患者免疫功能的作用;探讨胸腺5肽(TP-5)治疗免疫抑制的有效性.方法:符合严重脓毒症标准,CD+14单核细胞HLA-DR<30%的患者被定义为脓毒症免疫抑制和代偿性抗炎症反应综合征(CARS)者纳入本研究,并接受1 mg TP-5肌肉注射,1次/d,直至CD+14单核细胞HLA-DR>50%或死亡.在TP-5治疗前及结束治疗时分别测量CD+14单核细胞HLADR和肿瘤坏死因子-α(TNF-α)、白介素-6(IL6)、IL-10和IL-13.结果:15例患者存活,5例死亡.经TP-5治疗后所有患者的CD+14单核细胞HLA-DR均有不同程度提高,但仅存活者有显著差异.所有患者细胞因子均高于健康对照,治疗后存活患者的TNFα、IL-6明显下降;死亡者各种细胞因子变化不明显.结论:用CD+14单核细胞HLA-DR鉴别脓毒症免疫抑制并指导免疫刺激治疗是安全可靠的,且对评估预后有重要价值;TP-5可能对逆转免疫抑制有效,但需要严格的对照治疗研究确认;脓毒症的免疫抑制发生和逆转与促炎/抗炎细胞因子平衡无关,确切机制有待深入探讨.
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