中文摘要：

目的探讨严重烧伤患者人白细胞抗原DR（HLA—DR）定量表达的变化规律及其临床意义。方法采集77例烧伤大于体表总面积30％的患者的血样，通过流式细胞技术对患者烧伤后不同时段CD14^＋单核细胞表面HLA—DR结合量进行动态的定量分析。结果严重烧伤患者伤后第1天开始CD14^＋单核细胞表面HLA—DR结合量明显低于正常对照组（P〈0．05），其表达均值与烧伤面积呈显著负相关（r=-0．7232，P〈0．05）。并发多脏器功能障碍综合征（MODS）者其CD14^＋单核细胞表面的HLA—DR表达量持续下降，其中伤后第3、14、21、28天显著低于非MODS组（P〈0．05）。随着CD14^＋单核细胞HLA—DR表达水平的下降，MODS发生频率增加，患者预后不良。结论大面积烧伤可导致机体CD14^＋单核细胞HLA—DR表达严重受损和免疫功能障碍，动态观察其表达水平有助于烧伤后MODS的病程监测及患者预后判断。

英文摘要：

Objective To investigate the clinical significance of kinetic changes in quantitative expression of human leukocyte antigen DR （HLA-DR） in severely burned patients. Methods The blood samples of 77 extensively burned patients （ 〉 30% of total body surface area） were serially collected in the present study. The expression of HLA-DR on CD14^＋ mononuclear cell surface in burned patients were quantified by flow cytometry （using monoclonal antibody, QuantiBRITETM Anti-HLA-DR PE^＊/Anti- Monocyte PerCP-CyS. 5） on days 1, 3, 5, 7, 14, 21 and 28 post burn. Results The expressions of HLA- DR on CD14^＋ mononuclear cell surface in severely burned patients were significantly lower than those in healthy volunteers from the first day post burn （ P 〈 0. 05 ）, and the value of HLA-DR expression was negatively correlated with the burned area （ r = - 0. 7232, P 〈 0. 05 ）. The expression of HLA-DR in patients complicated with multiple organ dysfunction syndrome （MODS） was persistently decreased following major burns, and it was significantly lower than that of non-MODS patients on days 3, 14, 21 and 28 post burn （P 〈 0. 05 ）. The incidence rate of MODS rose markedly along with the lowering of HLA-DR expression, accompanied with poorer prognosis. Conclusions Extensive burns could result in marked damage in expression of HLA-DR on CD14^＋ mononuclear cell surface and immunologic dysfunction. Quantitative measurement of HLA-DR expression might be of significance in forecasting the development of MODS and prognosis in extensively burned patients.