围手术期去白悬浮红细胞输注对胃癌患者免疫功能、炎症因子及远期生存的影响

Effects of perioperative leukocyte-depleted suspended erythrocyte transfusion on immune function,inflammatory factors and long-term survival of patients with gastric cancer

目的探究围手术期去白悬浮红细胞输注对胃癌患者免疫功能、炎症因子及远期生存的影响。方法回顾性分析2013年6月至2017年6月四川省肿瘤医院收治的208例胃癌患者相关资料,依据患者围手术期行去白悬浮红细胞输注以及悬浮红细胞输注分为研究组(n=128)与对照组(n=80)。比较两组患者输注治疗疗效、输注前后免疫功能、炎症因子[干扰素-γ(IFN-γ)、白细胞介素-10(IL-10)、肿瘤坏死因子α(TNF-α)]、输注不良反应发生率、远期生存率。结果研究组患者输注总有效率(76.56%)显著高于对照组(55.00%),差异有统计学意义(P<0.05)。对照组输注后CD4^(+)、CD4^(+)/CD8^(+)、NK细胞水平显著低于输注前,CD8^(+)水平显著低于输注前,差异均有统计学意义(P<0.05),研究组患者输注前后CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、NK细胞水平差异无统计学意义(P>0.05);输注后研究组患者CD4^(+)、CD4^(+)/CD8^(+)、NK细胞水平分别为(36.13±9.00)%、(1.30±0.48)、(13.61±1.10)%,显著高于对照组[(29.75±6.29)%、(0.84±0.18)、(10.00±1.10)%],CD8^(+)水平为(30.33±7.14)%,显著低于对照组[(37.91±5.28)%],差异均有统计学意义(P<0.05)。两组患者输注后炎症因子IFN-γ、IL-10以及TNF-α水平明显低于输注前,差异均有统计学意义(P<0.05),且研究组患者IFN-γ、IL-10以及TNF-α水平分别为(15.37±5.10)、(12.25±3.60)、(13.08±4.02)pg/m L,显著低于对照组[(20.96±3.85)、(18.31±4.00)、(18.26±5.83)pg/m L],差异均有统计学意义(P<0.05)。研究组患者输注不良反应发生率(4.69%)与感染率(1.56%)均明显低于对照组(27.50%和20.00%),差异均有统计学意义(P<0.05)。研究组与对照组患者3年生存率分别为85.5%和84.6%,差异无统计学意义(Logrankχ^(2)=0.029,P>0.05)。结论胃癌患者围手术期去白悬浮红细胞输注可以减轻患者免疫抑制,下调炎症因子水平,而对患者远期生存率无影响。

Objective To explore the effects of perioperative leukocyte-depleted suspended erythrocyte transfusion on immune function,inflammatory factors and long-term survival of patients with gastric cancer.Methods The related data of 208 patients with gastric cancer who were admitted to Sichuan Cancer Hospital from June 2013 to June 2017 were retrospectively analyzed.They were divided into study group(n=128,perioperative leukocyte-depleted suspended erythrocyte transfusion)and control group(n=80,suspended erythrocyte transfusion).The curative effect of transfusion therapy,immune function,inflammatory factors[interferon-γ(IFN-γ),interleukin-10(IL-10),tumor necrosis factor alpha(TNF-α)],incidence of adverse transfusion reactions and long-term survival rate before and after treatment were compared between the two groups.Results The total response rate of transfusion in study group was significantly higher than that in control group(76.56%vs.55.00%),the difference was statistically significant(P<0.05).After transfusion,levels of CD4^(+),CD4^(+)/CD8^(+)and NK cells were significantly decreased,and CD8^(+)levels were increased in the control group,the differences were statistically significant(P<0.05),but there were no significant differences in the above indexes in study group before and after transfusion(P>0.05).After infusion,the levels of CD4^(+),CD4^(+)/CD8^(+)and NK cells in the study group were(36.13±9.00)%,(1.30±0.48),(13.61±1.10)%,which were significantly higher than those in the control group[(29.75±6.29)%,(0.84±0.18),(10.00±1.10)%],the CD8^(+)level was(30.33±7.14)%,which was significantly lower than the control group[(37.91±5.28)%],the differences were statistically significant(P<0.05).After transfusion,levels of inflammatory factors(IFN-γ,IL-10,TNF-α)in both groups were significantly decreased,the differences were statistically significant(P<0.05),and the levels of IFN-γ,IL-10 and TNF-αin the study group were(15.37±5.10),(12.25±3.60),(13.08±4.02)pg/mL,which were significantly lower than those in the control group[(20.96±3.85),(18.31±4.00),(18.26±5.83)pg/mL],the differences were statistically significant(P<0.05).The incidence of adverse transfusion reactions(4.69%)and infection rate(1.56%)in study group were significantly lower than those in control group(27.50%,20.00%),the differences were statistically significant(P<0.05).There was no significant difference in 3-year survival rate between study group and control group(85.5%vs 84.6%)(Log-rankχ2=0.029,P>0.05).Conclusion Perioperative leukocyte-depleted suspended erythrocyte transfusion in patients with gastric cancer can relieve immunosuppression,down-regulate levels of inflammatory factors,without influence on long-term survival rate.