稀释式自体输血对产妇外周血CD3＋、CD4＋、CD8＋细胞的影响

The influence of acute normovolemic hemodilution on the level of T lymphocyte subsets in maternity sera

目的 观察稀释式自体输血对产妇外周血CD3＋、CD4＋、CD8＋细胞的影响.方法 60例足月行剖宫产术的产妇根据输血方式不同分为两组,每组30例.A组为稀释式自体输血组,C组为异体输血组,术中观察记录产妇血压、心率、手术时间、出血量等,并于术前（T0）、术后第1天（T1）、术后第5天（T2）各采肘静脉血2 mL,以流式细胞仪法检测血CD3＋、CD4＋、CD8＋并计算CD4/CD8＋的比值.结果 两组产妇术前CD3＋、CD4＋、CD8＋、CD4＋/CD8＋差异均无统计学意义（P＞0.05）,两组产妇术后第1天CD3＋[分别为（52.35±5.62）％、（48.44±6.45）％]、CD4＋[分别为（36.90±7.93）％、（32.05±8.94）％]、CD4＋/CD8＋[分别为（1.15±0.26）、（0.97±0.22）]较术前CD3＋[分别为（59.67±3.45）％、（60.58±4.27）％]、CD4＋[分别为（43.71±8.45）％、（43.21±8.45）％]、CD4＋/CD8＋[分别为（1.41±0.38）、（1.45±0.48）]明显减少（t值分别为6.10、2.50;3.22、4.97;3.09、4.98;P＜ 0.05）,但A组CD3＋[（52.35±5.62）％、CD4＋（36.90±7.93）％、CD4＋/CD8＋（1.15±0.26）]明显高于C组CD3＋[（48.44±6.45）％、CD4＋ （32.05±8.94）％、CD4＋/CD8＋（0.97±0.22）],差异均有统计学意义（t =2.50、2.22、2.89,均P＜0.05）.术后第5天A组CD3＋、CD4＋、CD4＋/CD8＋[分别为（58.78±5.24）％、（43.18±8.48）％、（1.41±0.41）％]与术前（59.67±3.45）％、（43.71±8.45）％、（1.41±0.38）]比较差异无统计学意义（P＞0.05）,C组CD3＋[57.11±6.81）％、CD4＋ [（38.68±7.70）％]、CD4＋/CD8＋[（1.19±0.37）]仍较术前[（60.58±4.27）％、（43.21±8.45）％、（1.45±0.48）]明显减少,差异均有统计学意义（t =2.46、2.17、2.35,均P＜0.05）.结论 稀释式自体输血对产妇细胞免疫功能的抑制较异体输血轻,有利于产妇术后细胞免疫功能的恢复.

Objective To investigate the effect of acute normovolemic hemodilution on immune function by observing the level change of lymphocyte subsets in maternity sera.Methods 60 ASA I ～ Ⅱ parturients were divided into 2 groups,30 cases in each group.Parturients of group A received acute normovolemic hemodilution and parturients of group C received allogeneic blood transfusion.Blood pressure,heart rate,duration of the cesarean section and blood loss were observed.2mL blood samples were taken from the mothers＆#39;vein before the surgery,1 day after the surgery,5 days after the surgery.Flow cytometry was used to measure T lymphocyte subsets.Results The levels of CD3＋,CD4＋,CD8＋,CD4＋/CDs＋ before the surgery had no statistically significant differences between two groups （P 〉 0.05）.The levels of CD3＋ [（52.35 ±5.62）%,（48.44±6.45）%],CD4＋ [（36.90±7.93）%,（32.05 ± 8.94）%],CD4＋/CD8＋ [（1.15 ± 0.26）,（0.97 ± 0.22）] were much lower 1 day after the surgery than those of preoperation [CD3＋：（59.67 ± 3.45） %,（60.58 ± 4.27） % ; CD4＋：（43.71 ± 8.45） %,（43.21 ± 8.45） % ; CD4＋/CDs＋：（1.41 ±0.38）,（1.45 ±0.48）] in both two groups（t =6.10,2.50;3.22,4.97;3.09,4.98;P 〈0.05）.In group A,the levels of CD3＋,CD4＋,CD4＋/CD8＋ [（58.78 ± 5.24） %,（43.18 ± 8.48） %,（1.41 ± 0.41）] had no statistical differences 5 days after the surgery（P 〉 0.05） compared with those of preoperation.While in group C,the levels of CD3＋ [（57.11 ± 6.81） %],CD4＋ [（38.68 ± 7.70） %],CD4＋/CDs＋ [（1.19 ± 0.37）] were lower than the levels before the surgery[（60.58 ± 4.27） %,（43.21 ± 8.45） %,（1.45 ± 0.48）],and of the differences were statistically significant （t =2.46,2.17,2.35 ;P 〈 0.05）.Conclusion Compared with allegeic transfusion,acute normovolemic hemodilution could benefit the recovery of parturients by alleviate the inhibitory effect of transfusion on the immune function.