自体回收血液红细胞2,3-DPG、G-6-PD、PS表达的变化研究

Effects of Cell Salvage on Erythrocyte 2,3-Disphosphoglycerate and G-6-PD Levels and Phosphatidylserine Expression

目的探讨血液回收对红细胞2,3-DPG和G-6-PD水平和磷脂酰丝氨酸(PS)表达的影响。方法选择心脏择期手术患者30例,使用费森尤斯盘式连续式血液回收机进行术中血液回收,与静脉血相比,比较红细胞2,3-DPG和G-6-PD水平和磷脂酰丝氨酸(PS)的表达变化。同时,将回收红细胞静置6h,比较上述指标的变化。结果与静脉血相比,放置0h的红细胞2,3-DPG与G-6-PD活性明显高于静脉血(P值均<0.05)。流式细胞仪检测结果显示,两者红细胞膜PS表达的差异无统计学意义(P>0.05)。放置6h的回收红细胞2,3-DPG活性明显低于静脉血(P<0.01),而G-6-PD活性与静脉血的差异无统计学意义(P>0.05)。结论与静脉血相比,术中回收红细胞具有较好的携氧和抗氧化能力。但放置6h后的回收红细胞携氧能力不如静脉血。建议放置6h的回收红细胞不要回输。

Objective The aim of this study was to investigate the contribution of the perioperative cell salvage process to the change in erythrocyte 2,3-disphosphoglycerate（2,3-DPG）and glucose-6-phosphate dehydrogenase（G-6-PD）levels and phosphatidylserine（PS）expression using a self-control study.Methods Thirty patients undergoing elective heart and blood vessel surgery were enrolled.Blood was collected and processed using a Fresenius continuous autotransfusion system device.2,3-DPG and G-6-PD activities,as well as PS expression,from both venous and washed red blood cells（RBC）were measured.The indicators among washed RBC at 6h,and 0h,and venous RBC were compared.Results 2,3-DPG and G-6-PD activities in washed blood at 0hwere significantly higher than those in venous RBC（2,3-DPG,venous vs.washed blood P〈0.05;G-6-PD,venous vs.washed blood,P〈0.05）.Flow cytometry results showed no differences between venous blood and washed RBC at 0h（n=23,P〉0.05）.The 2,3-DPG activity decreased in washed RBC that was allowed to stand for 6hcompared with that in venous blood（venous vs.washed blood at 6h,P〈0.01）,whereas no significant difference was observed in G-6-PD activity（venous.vs.washed blood at 6h,P〉0.05）.Conclusion Compared with venous RBC,washed RBC from intraoperative cell salvage exhibited good oxygen-carrying and antioxidant capacities.However,the oxygen-carrying capacity of washed RBC that was allowed to stand for 6hwas not as good as that of venous RBC.Thus,the data suggest that washed RBC that was left to stand for more than 6hshould not be reinfused.