ABO血型因素对病人红细胞悬液输血反应的影响

Effects of ABO blood group factors on erythrocyte suspension transfusion reactions

目的探讨ABO血型因素对病人红细胞悬液输血反应的影响。方法试验Ⅰ收集呼和浩特市11家医院麻醉科2006年1月至2014年1月术中输入红细胞悬液病人12600例，统计输血反应[发热（体温超过输血前1℃）、过敏、溶血]的发生情况。试验Ⅱ选择术中输入红细胞悬液的外科手术病人120例，年龄18～55岁，体重45～75kg，性别不限，ASA分级Ⅰ或Ⅱ级，根据ABO血型分为4组（n=30）：A型血组（A组）、B型血组（B组）、O型血组（O组）和AB型血组（AB组）。红细胞悬液输注标准为Hb〈7g／L，维持Hb〉10g／L。于麻醉诱导前（T1）、输血前（T2）、输血后5min（T3）、1h（T4）、6h（T5）、24h（T6）时，取中心静脉血标本，采用ELISA法检测血浆TNF-α、IL-4和IL-10的浓度。结果12600例输入红细胞悬液的病人中，发生输血反应216例，输血反应发生率1．714％。不同ABO血型病人输血反应发生率由高到低依次为B型血〉AB型血〉A型血〉O型血（P〈0．05或0．01）。与B组比较，其余3组T3-T6时血浆IL-10和TNF-α浓度降低，血浆IL-4浓度升高（P〈0．05）；与AB组比较，A组和O组T3-T6时血浆IL-10和TNF-α浓度降低，血浆IL-4浓度升高（P〈0．05）；与O组比较，A组T3-T6时血浆IL-10和TNF-α浓度降低，血浆IL-4浓度升高（P〈0．05）。结论ABO血型因素可影响病人红细胞悬液输血反应，输血反应发生率由高到低依次为B型血〉AB型血〉A型血〉O型血。

Objective To investigate the effects of ABO blood group factors on erythrocyte suspension （RCS） transfusion reactions in patients. Methods Test Ⅰ A total of 12 600 patients in whom RCS was transfused during operation at the department of anesthesiology of Ⅱ hospitals of Inner Mongolia from January 2006 to January 2014 were selected. The occurrence of transfusion reactions （ fever [ an increase in body temperature〉1 ℃ than that before transfusion] , allergy, hemolysis） was recorded in the patients. Test Ⅱ A total of 120 RCS-transfused patients of both sexes, aged 18-55 yr, weighing 45-75 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , who underwent surgical operation, were divided into 4 groups （n=30 each） according to the blood group： blood group A group （group A） , blood group B group （group B） , blood group O group （group O） and blood group AB group （group AB）. The standard for RCS transfusion was defined as hemoglobin （Hb） 〈7 g/L, and Hb was maintained 〉 10 g/L. Before induction of anesthesia （T1）, before blood transfusion （ T2 ）, and at 5 min, and 1, 6 and 24 h after blood transfusion （T3_6 ）, blood samples were collected from the central vein for determination of the plasma tumor necrosis factor-alpha （TNF-α）, interleukin-4 （IL-4） and IL-10 concentrations by enzyme-linked immunosorbent assay. Results Among the 12 600 RCS-transfused patients, 216 cases developed transfusion reactions, and the incidence of transfusion reactions was 1.714%. For the patients of different blood groups, the incidence of transfusion reactions from the high to the low was blood group B, blood group AB, blood group A, and blood group O in turn （P〈0.05 or 0.01）. Compared with group B, the plasma TNF-α and IL-10 concentrations were significantly decreased, and the plasma IL-4 concentrations were increased at T3-T6 in the other three groups （P〈0.05）. Compared with group AB, the plasma TNF-α and IL-IO concentrations were significantly decreased, and the plasma IL-4 concentrations were increased at T3-T6 in A and O groups 〈P〈0.05）. Compared with group O, the plasma TNF-α and IL-10 concentrations were significantly decreased, and the plasma IL-4 concentrations were increased at T3-T6 in group A （P 〈 0.05 ）. Conclusion ABO blood group factors affect RCS transfusion reactions in the patients, and the incidence of transfusion reactions from the high to the low is blood group B, blood group AB, blood group A, and blood group O in turn.