术中输注红细胞对消化道肿瘤患者术后免疫功能的影响

THE EFFECT OF INTRAOPERATIVE RED BLOOD CELLS TRANSFUSION ON THE IMMUNE FUNCTION OF THE PATIENTS WITH GASTROINTESTINAL CARCINOMA

目的 探讨消化道肿瘤患者术中输入红细胞对术后免疫功能的影响.方法 采用流式细胞仪分别对118例消化道肿瘤患者术前、术后一周外周血NK细胞及T细胞含量进行测定;其中42例患者行术中输入异体悬浮红细胞2～4U（A组）,39例患者术中输入异体少白细胞红细胞2～4U（B组）,37例未行术中输血（C组）,对三组进行术前及术后外周血T细胞及NK细胞含量的比较.结果 A组和B组术后T细胞含量分别为（59.23±7.74）％和（62.12±6.43）％,明显低于C组（65.25±6.12）％（p＜0.05）;A组和B组与C组相比术后T细胞含量均有所降低,其中A组比B组降低更为明显（p＜0.05）.A组术后NK细胞含量降低为（11.23±5.74）％,明显低于B组（15.12±4.43）％和C组（16.22±4.12）％,A组术后与其它组相比NK细胞含量下降差异均有统计学意义（p＜0.05）.结论 术中输入异体红细胞可导致消化道肿瘤患者术后免疫功能降低,临床上应减少术中红细胞输注,选择少白红细胞可以减轻对免疫功能的影响.

Objective To evaluate the effect of intraoperative transfusion of red blood cells （RBCs） on post- operative immune function of patients with gastrointestinal carcinoma. Methods The preoperative and postoperative peripheral blood T cells and NK cells were detected by flow cytometry in 118 patients with gastrointestinal carcinoma, including 42 patients who had a transfusion of allogeneic packed red blood cell 4u （ Group A）, 39 patients who had a leukocyte - reduced red blood cells 4u （ Group B）, 37 patients did not accepted blood transfusion （ Group C）. The content of preoperative and postoperative peripheral blood T cells and NK cells in three groups was compared respectively. Results The content of postoperative T cells in Group A （59. 23 ± 7.74） % and Group B （62. 12 ± 6.43） % were significant lower than Group C （65.25 ± 6. 12）% （p 〈 0. 05 ）; Group A and Group B both had significant differences on the reduction of the content of T cells, and Group A was more obvious（p 〈 0.05）. The content of post- operative NK cells in Group A （11.23 ± 5.74）% were significant lower than and Group B （15.12 ± 4.43 ）% and Group C （ 16. 22 ±4. 12）% （p 〈 0.05）. Conclusion Intraoperative red blood cells transfusion can decrease the content of the peripheral blood T ceils and NK cells thus lead to the immune dysfunction of patients with gastrointestinal cancer, so intraoperative red blood cell transfusion should be reduced in the clinical practice, and the leukocyte - reduced red blood cells is a better choice for patients with gastrointestinal cancer.