术前MELD评分和术后CD14^＋／HLA—DR测定在肝移植术后感染预测中的意义

目的：探讨原位肝移植术前终末期肝病模型（MELD）评分和术后CD14^＋单核细胞人自细胞DR抗原（CD14^＋／HLA-DR）表达率的变化在术后感染预测中的临床意义。方法：按美国胸科医师协会／危重病医学会的定义，将83例肝移植术后患者分为非感染组、感染组、感染性休克组，分别测定3组患者术前血胆红素、凝血酶原时间国际标准化比值（INR）、血肌酐，计算MELD评分，并动态检测术后CD14^＋／HLA—DR表达率，分析其在感染监测中的价值。结果：感染组和感染休克组术前血胆红素、INR、血肌酐和MELD评分均显著高于非感染组（P〈0．01），CD14^＋／HLA-DR表达率均显著低于非感染组（P〈0．01）。感染组和感染休克组之间比较，上述指标均无显著性差异（P〉0．05）。感染发生后，感染组、感染性休克组的CD14^＋／HLA—DR值显著下降，与非感染组比较，差异具有显著性（P〈0．05或P〈0．01）；感染最重时两组的CD14^＋／HLA—DR值均降到最低值，与非感染组比较，差异具有显著性（P〈0．01）。结论：术前MELD评分和术后CD14^＋／HLA—DR表达率是监测肝移植术后感染发生及判断预后的良好指标。对术前高MELD评分或术后可疑感染的患者，动态监测CD14^＋／HLA-DR表达率对病情判断和治疗调整均有较好的指导意义。

Significances of preoperative model for end-stage liver disease scoring and postoperative CD14+ monocyte human leukocyte antigen-DR determination in predicting postoperative infection in patients with orthotopic liver transplantation

Objective：To investigate the significances of preoperative model for end-stage liver disease （MELD） score and postoperative changes in expression ratio of CD14^＋ monocyte human leukocyte antigen-DR （CD14^＋/ HLA-DR） in predicting postoperative infection of the patients with orthotopic liver transplantation. Methods： Eighty-three patients with orthotopic liver transplantation were divided into three groups, namely non-infection group, infection group and septic shock group by the definition of ACCP/SCCM. Before operation, CD14^＋/HLA- DR expression ratio was detected with flow cytometer, and plasma bilirubin, international normalized ratio （INR）, creatinine were measured to calculate the preoperative MELD score. The value of MELD score and CD14^＋/HLA-DR expression in predicting postoperative infection was analyzed. Results： Preoperative plasma bilirubin, INR, creatinine and MELD score in infection group and septic shock group were significantly higher and CD14^＋/HLA-DR expression ratio was significantly lower than those in non-infection group （P〈0.01）, but no significant difference of the above-mentioned parameters was found between infection group and septic shock group （P〉0. 05）. Compared with the non-infection group, the expression of CD14^＋/HLA-DR was lower in the infection group and septic shock group after infection occurred（P〈0. 05 and P〈0. 01）, and the expression rate was lowest during the period of serious infection in the two groups（both P〈0. 01）. Conclusion： Preoperative MELD score and CD14^＋/ HLA-DR expression ratio are the two significant markers to monitor the postoperative infection rate and to predict the prognosis of the patients with orthotopic liver transplantation. For the patients with high preoperative MELD values or possible infection after liver transplantation, consecutively detection of CD14^＋/HLA-DR expression ratio would beneficial in the judgment of patienfs conditions, and for the adjustment of therapeutic strategy.