【摘要】 目的探讨外周血单核细胞人类白细胞抗原DR(HLA-DR)表达的变化及其对神经重症监护病房(NICU)中,卒中相关性感染(SAI)的预测价值。方法连续入选发病24h内收入NICU的急性卒中患者53例,记录其入院第1、2和3天的NIHSS评分;以同期神经内科普通病房住院的头晕患者39例作为对照组。根据病后1周内是否发生感染,将卒中患者分为感染组24例和非感染组29例。采用流式细胞仪检测患者入院第1、2、4、6和14天单核细胞HLA-DR的表达;使用受试者工作特征(ROC)曲线,判断HLA-DR表达对SAI的预测价值。结果卒中组入院第1天HLA-DR表达即下降,之后逐渐上升,至第14天仍低于对照组(P<0.001)。卒中组中的感染组患者病后第4天HLA-DR降至最低,为(49±16)%,之后逐渐上升,第14天上升至(60±21)%,仍低于卒中组中的非感染组的(77±9)%(P=0.004);非感染组病后第2天HLA-DR亦降至最低(58±17)%,之后逐渐上升,第14天上升至(77±9)%。以第2天单核细胞HLA-DR表达低于57%为临界点,其对卒中SAI的发生有预测价值(敏感性83%,特异性83%,ROC曲线下面积为0.907,P<0.001)。卒中组入院第1天和第2天NIHSS评分与相同时间点HLA-DR表达均呈负相关(第1天:r=-0.442,P=0.001;第2天:r=-0.424,P=0.002)。结论卒中患者急性期单核细胞HLA-DR表达下降,HLA-DR表达的下降对SAI的发生有预测价值。更多还原

【Abstract】 Objective To investigate the changes of human leucocyte antigen-DR (HLA-DR) expression on peripheral monocytes and its predictive value to stroke-associated infection (SAI) in the neurological intensive care unit (NICU).Methods Fifty-three consecutive patients with acute stroke admitted to NICU within 24 hours of symptom onset were enrolled. The NIHSS scores were recorded on day 1, 2 and 3 after admission; 39 patients with dizziness admitted to general ward at the same time were used as controls. The patients with stroke were divided into infection (n=24) or non-infection (n=29) groups according to whether the infection occurred or not within 1 week after symptom onset. The monocytic HLA-DR expression on day 1, 2, 4, 6 and 14 after admission were determined by flow cytometry; the receiver operating characteristic (ROC) curve was used to estimate the HLA-DR expression on the predictive value of SAI.Results The HLA-DR expression reduced on day 1 in the stroke group, and then it increased gradually. It is still lower than the control group on day 14 (P<0.001). The HLA-DR decresed to the lowest level (49±16)% on day 4 after symptom onset in the infection group of the stroke group, and then increased gradually. It incresed to 60±21% on day 14, but it still lower than in the non-infection group(P=0.004). The HLA-DR expression also decreased to the lowest level (58±17%) 2 days after symptom onset in the non-infection group, then it began to increase gradually and increased to 77±9% on day 14. Using the monocytic HLA-DR expression lower than 57% on day 2 as a critical point, it had a predictive value on the occurrence of SAI in stroke patients (sensitivity 83%, specificity 83%, ROC area under curve 0.907, P<0.001). The NIHSS and HLA-DR expression on day 1 and 2 at the same time point had negative correlation (on day 1: r=-0.442, P=0.001; on day 2:r=-0.424, P=0.002) in the stroke group. Conclusions The monocytic HLA-DR expression decreased in patients with acute stroke, and it was associated with the severety of stroke. The decline of HLA-DR expression may increase the occurrence of SAI.更多还原