两种输血方式对人工全膝关节置换术患者凝血功能、免疫功能及炎症因子的影响

Effects of salvaged autotransfusion and allogeneic blood transfusion on coagulation function,immune function and inflammatory factors in patients undergoing total knee arthroplasty

目的观察回收式自体输血技术与异体输血技术对人工全膝关节置换术患者凝血功能、免疫功能及炎症因子的影响。方法选择2016年8月至2017年8月在该院进行手术置换人工全膝关节的53例患者作为手术中回收式自体输血组(A组),选取60例患者作为异体血输入组(B组)。检测术后1d及5d的两组患者凝血功能指标、免疫功能及炎症因子血液指标,观察回收式自体输血技术与异体输血技术对人工全膝关节置换术患者凝血功能、免疫功能及炎症因子的影响。结果 A组患者术后1d与术后5d凝血功能指标值比较差异无统计学意义(P>0.05);两组患者的凝血功能指标值比较差异无统计学意义(P>0.05);A组CD3+CD4+T细胞、CD3+CD8+T细胞与CD16+CD56+NK细胞的含量均高于B组,差异具有统计学意义(P<0.01);A组术后1d与5dTLR2+细胞与TLR4+细胞检测结果低于B组,差异有统计学意义(P<0.01);A组术后1d与术后5d的可溶性CD40配体(sCD40L)、中性粒细胞趋化因子-1(CINC-1)、肿瘤坏死因子-α(TNF-α)与白介素-6(IL-6)的各项指标值均低于B组,差异有统计学意义(P<0.01)。结论术中回收式自体输血对人工全膝关节置换术患者凝血功能无显著影响,而且能够增强T细胞与NK细胞介导的机体免疫应答反应,同时抑制了TLR2及TLR4受体所介导的炎性反应,值得临床进一步研究推广应用。

Objective To observe the effect of salvaged autotransfusion technique and allogeneic transfusion on coagulation function,immune function and inflammatory factors in patients undergoing total knee arthroplasty. Methods 53 patients undergoing surgical total knee arthroplasty in the hospital from August 2016 to August 2017 were selected as the salvaged autotransfusion group (Group A) and 60 patients were selected as the allogeneic blood transfusion group (Group B).The blood coagulation parameters,immune function and blood index of inflammatory factors were measured on the 1st and 5th day after operation in order to observe the coagulation function,immune function and inflammatory factors in patients undergoing total knee arthroplasty using salvaged autotransfusion technique and allogeneic blood transfusion technique influences. Results There was no significant difference in coagulation function indexes between the 1st postoperative day and 5th postoperative day in A group ( P >0.05).There was no significant difference in the coagulation indexes between the two groups ( P >0.05). The levels of CD3^+CD4^+ T cells,CD3^+CD8^+ T cells and CD16^+CD56^+ NK cells in A group were significantly higher than those in B group,and the differences were statistically significant ( P <0.01).The TLR2^+ cells and TLR4^+ cells in the A group 1st and 5th day after operation were lower than those in B group,and the differences were statistically significant ( P <0.01).The values of soluble CD40 ligand (sCD40L),cytokine-induced neutrophil chemoattractant 1 (CINC-1),tumor necrosis factor α(TNF-α) and interleukin-6 (IL-6) in A group were lower than those in B group on the 1st and 5th days after operation,and the differences were statistically significant ( P <0.01). Conclusion The salvaged autotransfusion has no significant effect on the coagulation function of patients undergoing total knee arthroplasty,and it can enhance the immune response mediated by T cells and NK cells,and inhibite the inflammatory response mediated by TLR2 and TLR4 receptors,which deserves further research and application.