同种输血对食管癌患者围手术期细胞因子的影响

Study of cytokines in esophageal cancer patients receiving perioperative allogeneic transfusion

目的 探讨同种输血对食管癌患者细胞因子生成的影响及相互关系。方法 食管癌患者手术常规输血18例 ,去白细胞输血 14例 ,采用生物素 亲和素系统测定技术检测患者围手术期常规输血和去白细胞输血后血清中IL 10、IFN γ和TNF α的浓度。结果 常规输血后第 1天与输血前相比血清中IL 10、IFN γ和TNF α浓度升高 ,且以IL 10、IFN γ变化尤为显著 ;输血后第 5天IFN γ和TNF α降低接近输血前水平 ,并明显低于去白细胞输血组 ,IL 10仍明显高于输血前水平。去白细胞输血后不同时间IL 10无显著性改变。结论 食管癌患者围手术期同种输血后血清中IFN γ和TNF α的降低与IL 10升高有关 ,而IL 10升高可能是患者同种输血后免疫抑制的最重要原因 ,输注去白细胞血液可减轻或去除这一作用。

Objective To study effects of allogeneic blood transfusion on the level of cytokines in esophageal cancer patients.Methods Serum IFN γ,TNF α and IL 10 of 18 esophageal cancer patients undergoing transthoracic esophageal resection who were exposed to allogeneic transfusions(non leukoreduced)were measured to compare with those of 16 similar patients undergoing same operations who were exposed to leukodepleted blood in the perioperative period.Results Serum TNF α, IFN γ, and IL 10 levels in patients exposed to nonleukoreduced allogeneic transfusions increased on the first day after transfusion,with the latter two cytokines showing significant elevation( P <0.05, P <0.01).On the 5 th day after transfusion, IFN γ and TNF α levels returned to pretransfusion levels, but were lower than those in patients receiving leukodepleted blood( P<0.05,P <0.01),while the IL 10 level remained high.IL 10 level in patients receiving leukoreduced blood were constant at different times.Conclusion Increase of serum IFN γ and TNF α levels in esophageal cancer patients exposed to allogeneic transfusions is probably related to elevation of IL 10 level.IL 10 Elevation may be one of the causes of immunosuppression in patients exposed to allogeneic blood transfusion.Transfusion associated immunosuppression may be alleviated by transfusion of leukocyte depleted blood.