急性等容稀释性自体输血与异体输血对剖宫产手术患者T细胞亚群、肝肾功能及炎性细胞因子水平的影响

Effects of Acute Isovolumic Dilution Autotransfusion and Allogeneic Transfusion on T Cell Subsets,Liver and Kidney Function and Inflammatory Factors Levels in Patients Undergoing Cesarean Section

目的:探讨急性等容稀释性(ANH)自体输血与异体输血对剖宫产手术患者T细胞亚群、肝肾功能及炎性细胞因子水平的影响。方法:回顾性分析我院于2016年7月~2019年8月期间收治的128例行剖宫产手术患者的临床资料,根据输血方式的不同将患者分为A组(n=64,异体输血)和B组(n=64,ANH自体输血),比较两组患者血常规指标[血红蛋白(Hb)、血细胞比容(HCT)、血小板(PLT)、红细胞(RBC)]、T细胞亚群、炎性细胞因子指标[C反应蛋白(CRP)、白介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)]和肝肾功能指标[天冬氨酸转氨酶(AST)、谷丙转氨酶(ALT)、肌酐(Cr)、尿素氮(BUN)],比较两组输血期间不良反应发生情况。结果:A组术后5dHb、HCT、PLT、RBC均下降(P<0.05);B组术后5dHb、HCT、PLT、RBC均高于A组(P<0.05)。两组患者术前、术后5dAST、ALT、Cr、BUN组间及组内比较差异均无统计学意义(P>0.05)。A组术后5dCD4^(+)/CD8^(+)、CD4^(+)均下降,CD8^(+)升高(P<0.05);B组术后5dCD4^(+)/CD8^(+)、CD4^(+)高于A组,而CD8^(+)则低于A组(P<0.05)。两组输血期间不良反应发生率对比未见统计学差异(P>0.05)。B组术后5dIL-6、CRP、TNF-α均低于A组(P<0.05)。结论:ANH自体输血对剖宫产手术患者T细胞亚群、炎性反应、肝肾功能及血常规影响作用较不明显且安全性较好。

Objective:To investigate the effect of acute normovolemic hemodilution(ANH)autotransfusion and allogeneic transfusion on T cell subsets,liver and kidney function and inflammatory factors levels in patients undergoing cesarean section.Methods:The clinical data of 128 cases of cesarean section in our hospital from July 2016 to August 2019 were analyzed retrospectively.According to the different ways of blood transfusion,the patients were divided into group A(n=64,allogeneic blood transfusion)and group B(n=64,Anh autotransfusion).The blood routine indexes[hemoglobin(Hb),hematocrit(HCT),platelet(PLT),red blood cell(RBC)],T cell subsets,inflammatory factors[interleukin-6(IL-6),C-reactive protein(CRP)and tumor necrosis factor-α(TNF-α)]and indexes of liver and kidney function[aspartate transaminase(AST),Alanine aminotransferase(ALT),Creatinine(CR),Urea nitrogen(BUN)]were compared between the two groups.Results:Hb,HCT,PLT and RBC in group A decreased 5 days after operation(P<0.05),the Hb,HCT,PLT and RBC in group B were higher than those in group A(P<0.05).There was no significant difference in AST,ALT,Cr and BUN between the two groups(P>0.05).CD4^(+)/CD8^(+),CD4^(+)decreased and CD8^(+)increased in group A(P<0.05);CD4^(+)/CD8^(+)and CD4^(+)in group B were higher than those in group A,but CD8^(+)was lower than that in group A(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).The levels of CRP,IL-6 and TNF-αin group B were lower than those in group A(P<0.05).Conclusion:ANH autotransfusion has no significant effect on T cell subsets,inflammatory reaction,liver and kidney function and blood routine in patients undergoing cesarean section,and it is safe.