滤过白细胞的输血对重症创伤患者T淋巴细胞亚群及炎症的影响

Effects of leukocyte-depleted blood transfusion on T-lymphocyte subsets and inflammation in patients with severe trauma

目的探讨滤过白细胞的输血对重症创伤患者T淋巴细胞亚群及炎症的影响。方法回顾性选取2019年1月至2020年9月于北京中医医院顺义医院诊治的重症创伤老年患者125例,41例输注滤过白细胞的成分血液患者作为研究组,42例输注全血患者作为对照组,42例不输血患者作为空白组。获取3组患者输注前后T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、炎症指标[白细胞介素-6(IL-6)、IL-2、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)]和非溶血性输血发热发生率。采用Logistic回归分析影响非溶血性输血发热发生的高危因素。结果较输注前,研究组、对照组、空白组CD3^(+)、CD4^(+)、CD8^(+)呈不同程度降低,研究组输注后3 d、1周降低程度低于对照组、空白组,差异均有统计学意义(P<0.05);输注后1周,研究组CD3^(+)、CD4^(+)、CD8^(+)与输注前比较,差异无统计学意义(P>0.05);空白组输注后3 d、1周CD4^(+)/CD8^(+)高于输注前,差异均有统计学意义(P<0.05),研究组和对照组输注后CD4^(+)/CD8^(+)与输注前比较,差异无统计学意义(P>0.05)。较输注前,研究组、对照组、空白组IL-6、IL-2、TNF-α、CRP呈不同程度升高,研究组输注后1周降低程度低于对照组、空白组,差异均有统计学意义(P<0.05);输注后1周研究组IL-6、IL-2、TNF-α、CRP与输注前比较,差异无统计学意义(P>0.05)。研究组非溶血性输血发热发生率为7.32%,低于对照组(28.57%),差异有统计学意义(P<0.05)。CD3^(+)、CD4^(+)、CD8^(+)降低,而CD4^(+)/CD8^(+)、IL-6、IL-2、CRP升高为非溶血性输血发热发生的独立影响因素(P<0.05)。结论滤过白细胞的输血可改善重症创伤患者T淋巴细胞亚群及炎症因子,对促进患者康复和提高预后有重要价值。

Objective To investigate the effects of leukocyte-depleted blood transfusion on T-lymphocyte subsets and inflammation in patients with severe trauma.Methods A total of 125 elderly patients with severe trauma in Shunyi Hospital of Beijing Traditional Chinese medicine hospital from January 2019 to September 2020 were enrolled,and divided into three groups.Study group(n=41)were infused with leukocyte-depleted blood transfusion,control group(n=42)were infused with whole blood transfusion,and blank group(n=42)were infused with no transfusion.Various indexes were compared among groups,including T-lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)),inflammation indicators[interleukin-6(IL-6),IL-2,tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)]and the incidence of non hemolytic transfusion fever.Logistic regression analysis was used to analyze the high risk factors of non hemolytic transfusion fever.Results CD3^(+),CD4^(+) and CD8^(+) were decreased in all groups after treatment,and the decrease was most obvious in study group at post-transfusion 3 d and 1 wk,the differences were statistically significant(P<0.05).CD3^(+),CD4^(+) and CD8^(+) in study group at post-transfusion 1wk had no significant difference with those before transfusion(P>0.05).CD4^(+)/CD8^(+) was increased in blank group at post-treatment 3d and 1wk,the differences were statistically significant(P<0.05).CD4^(+)/CD8^(+) of study group and control group had significant difference before and after transfusion(P>0.05).IL-6,IL-2,TNF-αand CRP were increased in all groups after treatment.The decrease degree of IL-6,IL-2,TNF-αand CRP at post-transfusion 1wk was the lowest in study group than those in control group and blank group,the differences were statistically significant(P<0.05).IL-6,IL-2,TNF-αand CRP in study group at post-transfusion 1wk had no significant difference with those before transfusion(P>0.05).The incidence of non-haemolytic febrile transfusion reaction in study group was 7.32%,which was lower than that in control group(28.57%),the difference was statistically significant(P<0.05).The decrease of CD3^(+),CD4^(+),CD8^(+) and the increase of CD4^(+)/CD8^(+),IL-6,IL-2,and CRP were independent influencing factors of non-haemolytic febrile transfusion reaction(P<0.05).Conclusion Leukocyte-depleted blood transfusion can improve T-lymphocyte subsets and inflammatory factors in elderly patients with severe trauma,which can promote the recovery and improve the prognosis.