围术期输血对肺癌患者外周血T细胞亚群、肿瘤坏死因子的影响

Effect of perioperative blood transfusion on T-cell subsets and Tumor Necrosis Factor in patients with lung cancer

目的 探讨围术期输血对肺癌患者免疫功能的影响。方法 分别以流式细胞仪和酶联免疫吸附法检测 60例非小细胞肺癌患者术前、术中 60min、术后 1、7d外周血T细胞亚群及血浆肿瘤坏死因子 (TNF)水平的变化。 3 5例健康人员为正常对照。结果 肺癌患者外周血中CD3 +、CD4+、CD4+/CD8+明显低于健康对照组 ,CD4+/CD8+变化尤为明显 (1.92± 0 .5、0 .5 0±0 .1,P <0 .0 1) ,而TNF、CD8+明显高于对照组。输血组在术后表现为CD3 +、CD4+/CD8+的降低和CD8+的明显升高 ,与未输血组比较差异有显著性 ,术后 1dCD4+下降显著 (16.5± 1.7、2 2 .5±1.7,P <0 .0 1)。围术期TNF变化不明显 ,术后 7dT细胞亚群和TNF趋于恢复。结论 肺癌患者免疫功能处于抑制状态 。

Objective To investigate the effect of perioperative blood transfusion on T-cell subsets,tumor necrosis factor (TNF) and immunosuppression in patients with lung cancer.Methods Sixty patients underwent pneumotomy form cancer,and 35 healthy subjects were included in this study.Blood samples were with drawn from peripheral vein before operation,and1,7 days after operation.Using Flow Cytometry and Enzyme Linked Immunosorbent Assay,T lymphocyte subsets and serum TNF were determined.Results CD 3 +,CD 4 +,CD 4 +/CD 8 + ratio in the patients were lower than in control group,TNF and CD 8+ were higher in the patients (P< 0.05). The Change in lymphocyte subsets (CD 4 +/CD 8 +) was specially obvious (1.92± 0.5, 1.59± 0.10, P< 0.01).CD 3 +、D 4 + and CD 4 +/CD 8 + ratio was significantly lower in the transfused groups,the level of CD 4 + was obviously lower 1 day after operation 16.5± 1.7, 22.5± 1.7, P< 0.01), The levels of TNF and T-cell subsets closely turn to the levels before operation at the 7th day after pneumotomy.Conclusion The patients with lung cancer show a decreased immune state and perioperative blood transfusion can result in further immunosuppression.