Study On Association Between Human Leukocyte Antigen Expression On Monocyte And Secondary Infection In Severe Acute Pancreatitis

[Objective] To explore the association between HLA-DR expression on monocyte and secondary infection in SAP, further to initially observe variation characteristics of HLA-DR in different AP syndrome patterns of Traditional Chinese Medicine (TCM) and the relation to infection.[Methods] The value of HLA-DR expression on monocyte was evaluated in 40 patients who were admitted into West China Hospital within 48h after symptom onset, then the value and variation characteristic were compared among mild and severe group, severe infection group and non-infection group, as well as patients in different TCM syndrome pattern groups.[Results] In 10 cases of MAP, 3 were classified as liver Qi stagnation, 6 as damp-heat in liver and gallbladder and 1 as excessive-heat in spleen and stomach; while in 30 cases of SAP, 3 were classified as liver Qi stagnation, 12 as damp-heat in liver and gallbladder, 7 as excessive-heat in spleen and stomach and 8 as Qi-blood disturbance, the results of Ridit analysis showed that the distribution of TCM syndrome patterns in MAP differed from that in SAP (P<0.05) . There was no case of infection or death in MAP while there were 4 deaths in SAP, 11 patients experienced secondary infection in the middle and late stage of the disease, the HLA-DR expression in SAP infection group was significantly lower than that in non-infection group (P<0.001). On Day 1, 4, 7 and 10, the optimal cutoff value of HLA-DR for predicting infection was 35.8%, 35.2%, 45.1% and 49.9%, with the sensitivity and specificity of 81.8% and 82.8%, 81.8% and 96.6%, 90.9% and 96.6%, 90.9% and 94.2%, respectively. HLA-DR was negatively correlated with APACHEII (r=-0.790, F=0.000), Ranson (r=-0.642, P=0.00) and Balthazar scores (r=-0.422, P=0.007). The HLA-DR expression was different in different TCM syndrome patterns: on Day 1, 4, 7 after admission, the HLA-DR expression in patients of Qi-blood disturbance was significantly lower than that of the other 3 TCM syndrome patterns (P<0.05), while there was a trend that the infection rate of Qi-blood disturbance group was higher than others.[Conclusion] HLA-DR expression on monocyte is a good immune parameter for predicting secondary infection in AP; it is of great significance to differentiate of symptoms and signs for the classification of syndromes on the early stage of AP so as to guide the therapy and decrease infection rate.