[The relationship between dysfunction of cell-mediated immunity and prognosis in severely burned patients]

To investigate the relationship between dysfunction of cell-mediated immunity and prognosis in severely burned patients.

Twenty-six patients with total burn surface area larger than 70% total body surface area (TBSA) were included in the present study, and they were divided into non-survival group (14 cases) and survival group (12 cases). Eleven healthy volunteers served as controls. The blood samples were collected on days 1, 3, 7, 14 postburn, the human leukocyte antigen-DR (HLA-DR) bound on CD14+ mononuclear cell surface of burned patients was quantified by flow cytometry (using monoclonal antibody, QuantiBRITE anti-HLA-DR PE/anti-monocyte PerCP-Cy5.5). The ability of T lymphocyte proliferation was determined by thiazolyl blue (MTT) method, and interleukin-2 (IL-2) release was measured by enzyme-linked immunosorbent assay (ELISA).

Compared to the survival group, the T lymphocyte proliferative activity (0.739+/-0.299 vs. 0.320+/-0.237) and IL-2 release [(11.02+/-2.50) ng/L vs. (8.21+/-2.63) ng/L] in non-survival group were significantly decreased on postburn day 14 (P < 0.01 and P < 0.05). The expression of HLA-DR on CD14+ mononuclear cell surface was persistently decreased in non-survivors, while it markedly elevated in survivors after 14 days postburn (P < 0.01).

The cellular immune function is consistently suppressed in severely burned patients. Sequential monitoring of T lymphocyte proliferation, IL-2 release, and the amount of HLA-DR on CD14+ mononuclear cell surface might be of clinical prognostic significance in patients with massive burn injury.