肿瘤患者围手术期自异体输血对输血相关免疫调节效应影响的比较

Effects of autologous and allogeneic blood transfusion in perioperative period on transfusion-related immunomodulation in tumor patients

目的:探讨肿瘤患者围手术期自体输血与异体输血对输血相关免疫调节效应的影响。方法:以孝感市中心医院2017年12月至2019年4月实施肿瘤根治术的患者60例为研究对象,随机分为观察组(围手术期采取自体输血)和对照组(围手术期采取异体输血),各30例。所有患者在术前、术后第1天、第7天采取外周静脉血标本,分别用流式细胞仪定量分析T淋巴细胞亚群百分比的变化;用酶联免疫吸附测定(ELISA)定量分析IL-2、IL-10和IFN-γ水平的变化。结果:(1)术后第1天,2组患者CD3^+、CD4^+、CD8^+细胞在T淋巴细胞中百分比与术前相比均明显减少(P<0.05);术后第7天,对照组的CD3^+、CD4^+、CD8^+细胞(外周血中极少存在双阳性T细胞)百分比仍显著少于术前(P<0.05),而观察组与术前比较,差异无统计学意义(P>0.05);且观察组CD3^+、CD4^+、CD8^+细胞百分比显著高于对照组(P<0.05)。(2)术后第1天,观察组IL-2、IFN-γ水平较术前显著性升高(P<0.05),IL-10水平与术前比较差异无统计学意义(P>0.05);对照组IL-2、IFN-γ水平与术前比较,差异无统计学意义(P>0.05),IL-10水平明显高于术前(P<0.05);术后第7天,观察组IL-2、IFN-γ、IL-10水平与术前比较,差异无统计学意义(P>0.05),而对照组IL-2、IFN-γ水平较术前显著减少(P<0.05),IL-10水平明显高于术前(P<0.05),观察组患者的IL-2、IFN-γ水平显著高于对照组患者(P<0.05),2组IL-10水平比较差异无统计学意义(P>0.05)。结论:肿瘤患者围手术期自体输血与异体输血均可显著影响输血相关免疫调节,自体输血对恶性肿瘤患者免疫功能影响较小,异体输血明显抑制患者免疫功能。

Objective:To investigate the effects of autologous and allogeneic blood transfusion in perioperative period on transfusion-related immunomodulation(TRIM)in patients with tumor.Methods:From Dec 2017 to Apr 2019,60 patients who underwent radical tumor resection in Xiaogan Central Hospital were randomly divided into diluted autotransfusion group(groupⅠ)and allogeneic transfusion group(groupⅡ),30 cases in each group.The peripheral venous blood samples of all patients were taken before operation,at the 1 st and 7 th postoperative days.The percentage of T lymphocyte subsets was quantified by flow cytometry.The levels of IL-2,IL-10 and IFN-γwere measured by ELISA.Results:(1)At the first day after operation,the percentage of CD3^+,CD4^+and CD8^+T cells in both groups significantly decreased compared with that before operation(P<0.05).At 7 th day after operation,the percentage of CD3^+,CD4^+and CD8^+T cells in groupⅡwas still significantly lower than that before operation(there were few double positive T cells in peripheral blood)(P<0.05),but there was no significant difference in groupⅠ(P>0.05),and the percentage of CD3^+,CD4^+and CD8^+T cells in groupⅠwas significantly higher than that in groupⅡ(P<0.05).(2)An the 1 st day after operation,the levels of IL-2 and IFN-γin groupⅠwere significantly higher than those before operation(P<0.05),but there was no significant difference in the level of IL-10(P>0.05).There were no significant differences in the levels of IL-2 and IFN-γin groupⅡ,but the level of IL-10 was higher than that before operation(P<0.05).At 7 th day after operation,there were no significant differences in the levels of IL-2,IFN-γand IL-10 in groupⅠ,but the levels of IL-2 and IFN-γsignificantly decreased in groupⅡcompared with those before operation(P<0.05),and the level of IL-10 significantly increased(P<0.05).The levels of IL-2 and IFN-γin groupⅠwere markedly higher than those in groupⅡ(P<0.05),but there was no significant difference in the level of IL-10(P>0.05).Conclusions:Autologous and allogeneic blood transfusion can significantly affect TRIM in perioperative period in tumor patients.Compared with autologous blood transfusion,allogeneic blood transfusion can significantly inhibit the immune function of patients.