【摘要】 目的 探讨早期目标血糖管理对脓毒症患者T淋巴细胞CD69、CD14~+单核细胞(HLA-DR)表达的影响及其临床意义。方法 90例脓毒症患者按随机数字表法分为三组:血糖控制A组(4.4~6.1mmol/L)30例、血糖控制B组(6.2~8.3 mmol/L)30例、血糖控制C组(8.4~10.0 mmol/L)30例。入住ICU时就给予早期目标血糖管理,分别在入院时(0 d)及治疗后第1、3、7天采集静脉血,应用流式细胞仪检测T淋巴细胞CD69、CD14~+单核细胞HLA-DR的表达水平。相同时间点观察APACHEⅡ评分,并计算28 d病死率、MODS发生率及低血糖发生率。结果 A组第1、3、7天CD69和HLA-DR表达水平均较入院时明显升高,差异有统计学意义(P均<0.05);B组第1、7天CD69表达水平较入院时明显升高,差异有统计学意义(P均<0.05),第3、7天HLA-DR表达水平与入院时比较差异有统计学意义(P<0.05);C组CD69和HLADR表达呈先降低后升高的趋势,第3、7天CD69表达水平与入院时比较差异均有统计学意义(P均<0.05),第1、7天HLA-DR表达水平与入院时比较差异有统计学意义(P<0.05)。三组APACHEⅡ评分第1、3、7天较入院时均降低,差异有统计学意义(P<0.05);第7天A组与B、C组比较显著降低,差异有统计学意义(P<0.05)。三组28 d死亡率、MODS发生率及低血糖发生率均无统计学意义(P均>0.05)。结论 目标血糖管理水平(4.4~6.1 mmol/L)能够促进CD69、HLA-DR的表达,有利于免疫稳态的恢复,可能对终止脓毒症患者免疫紊乱和免疫麻痹的恶性进程有利。更多还原

【Abstract】 Objective To explore the effect and significance of CD69 and HLA- DR in the early target glucose control therapy for the septic patients.Methods Ninety septic patients were randomly divided into three groups;target glucose control A group(n =30,glucose control in 4.4 ~6.1 mmol/L),target glucose control B group(n=30,glucose control in 6.2 ~ 8.3 mmol/L) and target glucose control C group(n =30,glucose control in 8.4 ~ 10.0 mmol/L).Target blood glucose was given on admission.The expression level of CD69/HLA- DR was determined on day 0(on admission)and on day 1,day 3 and day 7 after admission by flow cytometry.APACHE Ⅱ score,28 days(d)mortality,the MODS and hypoglycemia incidence rate were also recorded and compared.Results Compared with day 0,the level of CD69 and HLA- DR were significantly raised in group A(P <0.05);Compared with day 0,CD69 expression level in group B was significantly increased on day 1 and day 7,HLA- DR expression level was significantly increased on day 1 and day 7(P < 0.05);Compared with day 0,CD69 and HLA- DR expression was reduced after the first rising trend,CD69 expression level was significantly increased on day 3 and day 7,HLA- DR expression level was significantly increased on day 1 and day 7(P < 0.05).In the three groups,the Score of APACHE II on day 1,day 3 and day 7 were reduced than that on day 0,and the difference was statistically significant(P < 0.05) j The APACHE H score on day 7 in group A was significandy lower than that in group B and C(P < 0.05).The 28 days(d) mortality and the MODS incidence rate of group A was lower than group B,C,but the difference was not significant(P >0.05).The hypoglycemia incidence rate was not significant among the three groups(P > 0.05).Conclusion Target glucose control management at4.4 ~6.1 mmol/L results in increased level of CD69 and HLA- DR,which helps to terminate the immune paralysis and immune disorders in ill patients with sepsis and promotes the recovery of immunity homeostasis.更多还原