文章摘要
贮存式自体成分输血对胃肠肿瘤患者围术期免疫功能的影响
Effect of allogeneic blood transfusion and preoperative autologous blood donation on perioperative immune function in patients with gastrointestinal tumor
  
DOI：10.12089/jca.2018.02.010
中文关键词: 贮存式自体成分输血  胃肠肿瘤  细胞免疫  体液免疫
英文关键词: Preoperative autologous blood donation  Gastrointestinal neoplasms  Cellular immunity  Humoral immunity
基金项目:国家自然科学基金（81671919）；上海市浦东新区卫生系统重点学科群建设项目（PWZxq2017-10）；上海市公共卫生重点学科建设项目（15GWZK0501）
作者单位E-mail
周循 200135,上海市,第二军医大学附属公利医院麻醉科  
王欢 200135,上海市,第二军医大学附属公利医院麻醉科  
刘小倩 200135,上海市,第二军医大学附属公利医院麻醉科  
朱娜娜 200135,上海市,第二军医大学附属公利医院麻醉科  
夏荣 复旦大学附属华山医院输血科  
郭建荣 200135,上海市,第二军医大学附属公利医院麻醉科 jianrguo@126.com 
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中文摘要:
      目的 观察贮存式自体成分输血与异体输血对胃肠恶性肿瘤患者围术期细胞免疫和体液免疫的影响。方法 选择择期全麻下行胃肠肿瘤根治手术患者60例, 男33例, 女27例, 年龄53～69岁, 体重47～70 kg, ASA Ⅰ或Ⅱ级。术中出血200～400 ml, Hb<70 g/L时启动输血, 将患者随机分为两组,每组30例。贮存式自体成分输血组(P组): 术中输血时采用贮存式自体成分输血;异体输血组(A组): 输血时采用异体输血。测定入室时、术毕即刻、术后1、3、7 d外周血中T淋巴细胞亚群、NK细胞百分比和IL-2、IL-10、TNF-α、穿孔素(perforin, PF)浓度。结果 与入室时比较,术毕即刻至术后7 d A组CD3+、CD4+、NK细胞百分比和CD4+/CD8+比值明显降低(P＜0.05);术后3、7 d A组CD3+、CD4+、NK细胞百分比和CD4+/CD8+比值明显低于P组(P＜0.05);术后1～7 d A组IL-2浓度明显低于, IL-10浓度明显高于P组(P＜0.05)。与入室时比较, 术毕即刻至术后3 d A组IgG、IgA含量明显降低(P＜0.05);术毕即刻P组IgG、IgA含量明显降低（P＜0.05）, 术后1、3 d恢复至术前水平。结论 围术期异体输血可降低肿瘤患者T细胞亚群和NK细胞百分比并延长其恢复时间, 也可一过性降低血浆中免疫球蛋白IgG、IgA含量, 从而影响患者的免疫功能, 而贮存式自体成分输血对肿瘤患者术后免疫功能的影响轻微。
英文摘要:
      Objective To investigate the effect of allogeneic transfusion and preoperative autologous blood donation on perioperative cellular immunity and humoral immunity in patients with gastrointestinal neoplasms. Methods Sixty gastrointestinal cancer patients undergoing radical surgery, 33 males and 27 females, aged 53-69 years, weighing 47-70 kg, ASA physical status Ⅰ or Ⅱ, were included in this study. Blood transfusion was started when the blood loss was more than 200-400 ml, Hb<70 g/L, and the patients were randomly divided into the preoperative autologous blood donation group (group P, n=30): intraoperative blood transfusion using the stored autologous blood transfusion; allogeneic blood transfusion group (group A, n=30): allogeneic blood transfusion. The levels of T lymphocyte subsets, NK cells and IL-2, IL-10, TNF-α, perforin (PF) concentration and plasma immunoglobulin IgG, IgA and IgM levels. Results The percentage of CD3+, CD4+, NK cells and the ratio of CD4+/CD8+in group A at the end of surgery to 7 d after operation were significantly lower than those at the time of admission (P＜0.05). The percentage of CD3+, CD4+ (P＜0.05). The level of IL-2 in group A was significantly lower than that in group P (P＜0.05) 1-7 d after operation, and the level of IL-10 in group A was significantly higher than that in group P (P＜0.05). The levels of IgG and IgA 3 d after operation in group A were significantly lower than those in group P (P＜0.05). The levels of IgG and IgA in group P were significantly decreased at the end of operation and recovered to preoperative levels 1-3 d after operation (P＜0.05). Conclusion Allogeneic blood transfusion can reduce the percentage of T-cell subsets and NK cells in cancer patients and delay their recovery, and also can transiently reduce the content of immunoglobulin IgG and IgA in plasma and thus affect the immune function of patients. However, the preoperative autologous blood donation has a slight effect on postoperative immune function in cancer patients.
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