不同输血方式对围术期患者炎性因子及免疫球蛋白水平的影响

Effect of different transfusion methods on levels of inflammatory factors and immune globulin during perioperative period

目的探讨不同的输血方式在围术期内对患者的相关炎性因子以及免疫球蛋白水平的影响,以寻求最佳的围术期输血方式。方法选择2013年4月至2016年4月在本院接受手术治疗的84例围术期输血患者,按照随机原则分为2组,其中自体组患者采取自体输血方式,而另42例患者采用异体输血的方式,对比2组患者在术前、术后第1天、术后第7天时的炎性因子白介素-1β(IL-1β)、白介素-6(IL-6)、白介素-8(IL-8)、肿瘤坏死因子-α(TN F-α)以及免疫球蛋白水平IgG、IgA、IgM的水平。结果 2组患者术后的IgG、IgA均出现了一定程度下降,和术前相比差异有统计学意义(P<0.05),同时异体输血组下降程度更重,远远超过自体组,差异有统计学意义(P<0.05);而术后第7天2组患者的免疫球蛋白水平均有所回升,但异体组回升速度明显不及自体组,差异有统计学意义(P<0.05);此外,在术后第1天,2组患者的IL-1β同时出现升高现象,但与术前相比差异无统计学意义(P>0.05),而IL-6、IL-8、TN F-α则有明显的升高(P<0.05);而在术后第7天,自体组患者的IL-6、IL-8、TN F-α仍明显高于异体组(P<0.05)。结论相比于异体输血,自体输血应用于围术期患者中在提高炎性因子和调控免疫球蛋白水平方面更具优势,故对其免疫功能的影响程度更小、更安全,也一定程度的减少了术后感染的发生率。

Objective To explore the effect of different transfusion methods on the levels of inflammatory factors and immune globulin during the perioperative period and seek the best transfusion method. Methods A total of 84 pa- tients were selected and randomly and equally divided into an autologous group and an allogenic group from April 2013 to April 2016. The patients in the autologous group received the autologous transfusion and the patinets in the allogenic group received the allogenic transfusion. Before surgery, 1 d and 7 d after the surgery, the levels of IL-1β, IL-6, IL-8 and TNF-α as well as the levels of IgG, IgA and IgM of the two groups were detected and compared. Results After the surgery, the levels of IgG and IgA in two groups were bother lower than before （P〈0.05）, and the levels of IgG and IgA in the allo- genic group was even lower than those in the autologous group （P〈0.05）; 7 d after the surgery, the levels of immune globulin in two groups were increased, and the level of immune globulin in the autologous group was higher than that in the allo- genic group （P〈0.05）; 1 d after the surgery, the levels of IL-1β in two groups were both increased but there was no signifi- cant difference compared with the levels before the surgery （P〉0.05）, but the levels of IL-6, IL-8, and TNF-α were signifi- cantly increased （P〈0.05）; 7 days after the surgery, the levels of IL-6, IL-8 and TNF-α in the autologous group were higher than those in the allogenic group （P〈0.05）. Conclusion Compared with the allogenic transfusion, the autologous trans- fusion has a better effect in the improvement of inflammatory factors and control of immune globulin, and therefore it has a fewer impact on the immune function and higher safety for the patients, and reduces the incidence of postoperative infection.