[Changes in human leukocyte antigen-DR expression on monocytes and its value of prediction on infection complication in trauma patients].

ObjectiveTo observe the changes of human leukocyte antigen DR(HLADR) expression in monocytes of trauma patients and its value of prediction on infection complications. MethodsFiftyfour trauma patients were divided into three groups according to severity of injury: severe trauma group 〔injury severity score(ISS)≥25〕, moderate trauma group(16≤ISS25) and mild trauma group(ISS16). In addition , 34 severe trauma patients(ISS≥16) were divided into three groups according to infection or not: no infection group, localized infection group and systemic infection group. Blood samples were collected immediately after admission and serially at 8:30 to 9:00 a.m.on days 1, 2, 4, 6, 8, 14 after admission, and monocyte HLADR expression was determined with monoclonal staining and flow cytometry. Results The HLADR expression in monocytes was reduced in the trauma patients. The lowest levels of HLADR were recorded on day 2 after trauma. Subsequently HLADR expression in monocytes increased gradually . During the whole observation, the HLADR expression was significantly decreased in both severe trauma group and moderate trauma group versus control group, but no significant differences were found between severe trauma group and moderate trauma group, mild trauma group and control group. Immediately after trauma , HLADR expression in monocytes was significantly lower in the localized infection group than that in the patients without infection, and lasted until day 4 after trauma. The mean fluorescence intensity of HLADR expression in monocytes on the day 2 to 14 after trauma, the percentage of HLADR monocytes on the day 1 to 14 after trauma were significantly lower in the systemic infection group than those in the localized infection group. The level of HLADR expression in monocyte in the 2 died trauma patients was lowered till died. ConclusionIn severe trauma patients, the HLADR expression in monocytes is significantly decreased, and decreased levels of HLADR expression in monocytes might be the early indicators of an immune deviation associated with the development of infection complications and prognosis.