创伤后多脏器功能衰竭患者白细胞流变性和细胞粘附分子水平的变化

目的：探讨创伤后多器官功能衰竭（MOF）患者白细胞流变性和细胞粘附分子（CAMs）水平的变化。方法：采用DXC-300A型核孔膜红细胞变形能力测定仪、JYJ-Ⅲ型体外血栓血小板粘附两用仪、酶联免疫吸附法（ELISA），分别检测了36例创伤后MOF患者、31例创伤患者和35例健康人外周血液白细胞变形能力（LD）、白细胞粘附功能（LAF）、白细胞CD18表达、血浆可溶性细胞间粘附分子-1（sICAM-1）和可溶性血管细胞间粘附分子-1（sVCAM—1）的变化。结果：MOF患者白细胞滤过指数（LFI）、白细胞粘附率（LAR）、白细胞CD180表达、sICAM—1，sVCAM—1均明显增高，与对照组和创伤组比较差异有极显著性（F=68．45-116．20，q=12．161—21、374，P〈0．001），MOF组死亡者各指标变化较存活者更明显（t=6．920—11．665，P〈0，001）。MOF患者LFI和LAR与sICAM—1，sVCAM—1和白细胞CD18表达呈正相关（r=0．691～0．844，P〈0．001），LFI与LAR呈正相关（r=0．771，P〈0．001）。结论：白细胞流变性和CAMs水平异常参与了MOF的发生，且与病情严重程度有密切关系。

Changes of leukocyte rheological characteristic and celladhesion molecule in patients with MOF after severe trauma

Objective: To explore the changes of leukocyte rheological characteristic and cell adhesion molecule in patients with multiple organ failure(MOF) after severe trauma.Methods: By using the erythrocyte deformability apparatus,platelet and thrombus adhesion dual-purpose apparatus and enzyme-linked immunosorbent assay(ELISA),we measured the leukocyte deformability(LD),leukocyte adhesion function(LAF),leukocyte CD18 expression,soluble intercellular adhesion molecule-1(sICAM-1) and soluble vascular cell adhesion molecule(sVCAM-1) concentration in 36 MOF patients,31 trauma patients, and 35 healthy controls.Results: The leukocyte filtration index(LFI),leukocyte adhesion rate(LAR),leukocyte CD18 expression,and sICAM-1 and sVCAM-1 concentration were significantly higher in MOF patients than in controls and trauma patients(F=68.45-116.20,q=12.161-21.374,P<0.00=,and the changes of these indicators in MOF deaths were more obvious than those in MOF survivors(t=6.920-11.665,P<0.00=.The LFI and LAR in MOF patients were positively related to leukocyte CD18 expression,sICAM-1,and sVCAM-1 concentration(r=0.691-0.844,P<0.001=;LFI was positively related to LAR(r=0.771,P<0.001=.Conclusion: The abnormalities of leukocyte rheologic characteristic and CAMs might be closely related to the occurrence of MOF and the severeness of pathologic changes.