贮存式自体成分输血对胃肠肿瘤根治术患者T淋巴细胞亚群、血液流变学和预后的影响

The Effect of Stored Autologous Blood Transfusion on T Lymphocyte Subsets,Hemorheology and Prognosis in Patients with Radical Resection of Gastrointestinal Tumor

目的:研究贮存式自体成分输血对胃肠肿瘤根治术患者T淋巴细胞亚群、血液流变学以及预后的影响。方法:选取2016年12月~2017年12月我院收治的95例行胃肠肿瘤根治术的胃肠肿瘤早期患者作为研究对象。按随机数表法分为A组(n=47,贮存式自体成分输血)和B组(n=48,异体成分输血)。比较两组患者血常规指标[红细胞计数(RBC)、血红蛋白(Hb)、血细胞比容(Hct)]、免疫功能指标(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、血液流变学指标[红细胞沉降率、平均血液黏度、红细胞刚性指数及红细胞变形指数]的变化。随访患者2年,采用Kaplan-Meier曲线分析两组预后情况。结果:术前至术后7 d时间段A组的CD3^(+)、CD4^(+)水平及CD4^(+)/CD8^(+)呈先降低后升高趋势,且术后7 d已恢复至术前水平;B组术后1 d、3 d、7 d的CD3^(+)、CD4^(+)水平及CD4^(+)/CD8^(+)明显低于A组(P<0.05),两组CD8^(+)水平相比无差异(P>0.05)。两组术后7 d的RBC、Hct、Hb分别较输血前下降(P<0.05),但两组间比较差异无统计学意义(P>0.05);两组患者术后7 d的红细胞沉降率均升高,但A组低于B组(P<0.05),两组患者术后的红细胞变形指数、平均血液黏度和红细胞刚性指数比较无差异(P>0.05)。Kaplan-Meier检验结果显示,A组较B组生存率明显升高(P<0.05)。结论:贮存式自体成分输血对胃肠肿瘤根治术患者红细胞沉降率、细胞免疫功能的影响程度较异体成分输血减轻,且贮存式自体成分输血可以明显提高患者的术后生存率。

Objective:To study effect of stored autologous blood transfusion on T lymphocyte subsets,hemorheology and prognosis in patients with radical resection of gastrointestinal tumor.Methods:From December 2016 to December 2017,95 patients with early gastrointestinal tumor undergoing radical gastrectomy in our hospital were selected as the study object.According to the method of random number table,the patients were divided into two groups:Group A(n=47,stored autologous component transfusion)and Group B(n=48,allogeneic component blood transfusion group).The routine blood index[red blood cell count(RBC),hemoglobin(Hb),hematocrit(Hct)],immune function index(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)),hemorheology index[erythrocyte sedimentation rate,average blood viscosity,erythrocyte rigidity index and erythrocyte deformation index]change of two groups patients were compared.Patients were followed up for 2 years,and the prognosis of the two groups was analyzed by Kaplan-Meier curve.Results:The levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)in group A decreased first and then increased,and returned to the preoperative level 7 d after operation.The levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)in group B were significantly lower than those in group A 1 d,3 d,7 d after operation(P<0.05),but there was no difference in the level of CD8^(+)between the two groups(P>0.05).The RBC,Hct and Hb of the two groups decreased at 7 d after operation compared with that before transfusion(P<0.05),but there was no statistically significant difference between the two groups(P>0.05).The erythrocyte sedimentation rate of both groups was increased 7 d after operation,but the Group A was lower than Group B(P<0.05).There were no statistically significant differences in erythrocyte deformation index,mean blood viscosity and erythrocyte rigidity index between the two groups(P>0.05).Kaplan-Meier test results showed that the survival rate of the Group A was significantly higher than that of the Group A(P<0.05).Conclusion:The effect of stored autologous component transfusion on erythrocyte sedimentation rate and cellular immune function in patients undergoing radical resection of gastrointestinal tumor are less than those of allogeneic component blood transfusion,and the survival rate of the patients was significantly improved by stored autologous component transfusion.