红细胞输注对肝癌患者CD4^+T辅助细胞免疫功能的影响

Influence of red blood cell transfusion on CD4^+T-helper cells in liver cancer patients

目的探讨输入异体红细胞对肝癌患者外周静脉血中CD4+辅助性T淋巴细胞(helper T cells,Th)向Th1/Th2细胞亚群分化和相应细胞因子分泌的影响。方法选取45例肝细胞癌患者,其中未输血患者20例(未输血组),输入过异体红细胞患者25例(输血组)。应用流式细胞仪检测2组患者外周血Th1(CD4+IFN-γ+)、Th2(CD4+IL-4+)的含量。采用酶联免疫吸附测定法检测2组患者外周血白细胞介素2(interleukin 2,IL-2)、干扰素γ(interferon-γ,INF-γ)、IL-12(Th1型细胞因子)以及IL-4、IL-6、IL-10(Th2型细胞因子)的水平。结果输血组Th1含量较未输血组明显降低(P<0.01),而Th2含量较未输血组则明显升高(P<0.01),但2组Th/CD4+T水平变化不明显(P>0.05)。同时,输血组IL-2、INF-γ和IL-12的水平明显低于未输血组(P<0.01),IL-4、IL-6和IL-10的水平明显高于未输血组(P<0.01)。结论输入异体红细胞可导致肝癌患者体内Th1/Th2平衡向Th2偏移,同时Th1亚群免疫反应功能抑制,Th2亚群免疫反应功能亢进。临床上应尽量减少肝癌患者红细胞输注,以减轻对患者的免疫抑制。

Objective To study the changes of Th1/Th2 subsets and cytokines of CD4＋Thelper cells in peripheral blood of patients with hepatocellular carcinoma after blood transfusion of allogeneic red blood cells.Methods There were 45 patients with hepatocellular carcinoma,including 20 cases without blood transfusion（non-transfusion group）and 25 cases with blood transfusion of allogeneic red cells（transfusion group）.The Th1 and Th2in peripheral blood were examined in 45 patients by flow cytometry.Enzyme-linked immunosorbent assay was used to detect the level of serum interleukin-2（IL-2）,IL-12,interferon-γ（INF-γ）,IL-4,IL-6,and IL-10in45 patients.IL-2,INF-γand IL-12 were used to represent cytokines of Th1 type,and IL-4,IL-6and IL-10 to represent cytokines of Th2 type.Results The level of Th1 in transfusion group was significantly lower than that in non-transfusion group（P〈0.01）,but the level of Th2 in transfusion group was significantly higher than that in non-transfusion group（P〈0.01）.The change of Th/CD4＋T in two groups was not significant（P〈0.05）.The level of IL-2,TNF-γand IL-12 in transfusion group were significantly lower than those in non-transfusion group（P〈0.01）,but the levels of IL-4,IL-6and IL-10 were significantly higher in transfusion group than those in non-transfusion group（P〈0.01）.Conclusion Blood transfusion of allogeneic red cells induces a shift of the Th1/Th2 balance toward Th2 dominance.At the same time,subpopulation Th1 immune response was suppressed,Th2 subsets showed overactive immune response.Transfusion of allogeneic red blood cells should be avoided in liver cancer patients to reduce the immune suppression of blood transfusion.