肝门部胆管癌患者围手术期输血与术后免疫功能及预后的关系

Correlations of perioperative blood transfusion with postoperative immune function and prognosis in patients with hilar cholangiocarcinoma

目的观察围手术期输血的肝门部胆管癌患者术后免疫功能和预后情况,探讨肝门部胆管癌患者围手术期输血对术后免疫功能和预后的影响。方法2017年6月—2020年11月商丘市第一人民医院诊治肝门部胆管癌患者105例,均行胆管癌根治性切除术,根据围手术期输血方式分为无输血组65例,自体输血组15例,异体输血组25例,应用流式细胞仪检测3组术前及术后7 d外周血CD3^(+)、CD4^(+)、CD8^(+)T淋巴细胞及自然杀伤(NK)细胞比率,并进行比较。比较3组Bismuth-Corlette分型、肿瘤最大径等临床资料及自体输血组与异体输血组围手术期输血量。术后随访3~62个月,比较3组术后1、2年总生存率。结果3组Bismuth-Corlette分型、肿瘤最大径、分化程度及淋巴结转移比率比较差异均无统计学意义(P>0.05)。自体输血组围手术期输血量[(323.36±65.50)mL]与异体输血组[(289.69±55.60)mL]比较差异无统计学意义(t=1.841,P=0.069)。3组术前外周血CD3^(+)、CD4^(+)、CD8^(+)T淋巴细胞及NK细胞比率比较差异均无统计学意义(P>0.05)。异体输血组术后7 d外周血CD3^(+)、CD4^(+)T淋巴细胞及NK细胞比率均低于术前(P<0.05),CD8^(+)T淋巴细胞比率高于术前(P<0.05);无输血组、自体输血组术后7 d外周血CD3^(+)、CD4^(+)、CD8^(+)T淋巴细胞及NK细胞比率与术前比较差异均无统计学意义(P>0.05)。异体输血组术后7 d外周血CD3^(+)、CD4^(+)T淋巴细胞及NK细胞比率[(62.66±7.96)%、(31.03±6.50)%、(6.98±2.03)%]均低于无输血组[(69.83±9.23)%、(37.03±8.80)%、(8.98±2.89)%]、自体输血组[(68.98±7.05)%、(36.50±6.25)%、(8.50±2.56)%](P<0.05),CD8^(+)T淋巴细胞比率[(30.93±6.26)%]均高于无输血组[(25.06±9.03)%]、自体输血组[(25.26±6.62)%](P<0.05);无输血组术后7 d外周血CD3^(+)、CD4^(+)、CD8^(+)T淋巴细胞及NK细胞比率与自体输血组比较差异均无统计学意义(P>0.05)。无输血组、自体输血组、异体输血组术后1年(43.1%、33.3%、32.0%)、2年(30.8%、20.0%、20.0%)总生存率比较差异均无统计学意义(χ^(2)=1.171,P=0.557;χ^(2)=1.179,P=0.480)。结论肝门部胆管癌患者围手术期异体输血损害患者术后早期免疫功能,但对患者远期生存状况无明显影响。

Objective To observe the postoperative immune function and prognosis of patients with hilar cholangiocarcinoma who received perioperative blood transfusion,and to explore the influence of perioperative blood transfusion on postoperative immune function and prognosis.Methods One hundred and five patients with hilar cholangiocarcinoma underwent radical resection in the First People's Hospital of Shangqiu from June 2017 to November 2020.According to the perioperative blood transfusion methods,105 patients were divided into non-transfusion group(n=65),autologous transfusion group(n=15)and allogeneic transfusion group(n=25).The percentages of T lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+))and natural killer(NK)cells were detected by flow cytometry in three groups before and 7 days after operation and were compared.The clinical data such as Bismuth-Corlette classification and maximum tumor diameter were compared among three groups,and the perioperative blood transfusion volume was compared between autologous transfusion group and allogeneic transfusion group.All patients were followed up for 3 to 62 months postoperatively,and 1-and 2-year overall survival rates were compared among three groups.Results There were no significant differences in the Bismuth-Corlette classification,maximum tumor diameter,degree of differentiation and lymph node metastasis among three groups(P>0.05).There was no significant difference in the perioperative blood transfusion volume between autologous transfusion group[(323.36±65.50)mL]and allogeneic transfusion group[(289.69±55.60)mL](t=1.841,P=0.069).There were no significant differences in the percentages of T lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+))and NK cells among three groups before operation(P>0.05).The percentages of T lymphocyte subsets(CD3^(+),CD4^(+))and NK cells were lower by day 7 after operation than those before operation in allogeneic transfusion group(P<0.05);and the percentage of CD8^(+)T lymphocytes was higher than that before operation(P<0.05).There were no significant differences in the percentages of T lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+))and NK cells by day 7 after operation compared with those before operation in non-transfusion group and autologous transfusion group(P>0.05).The percentages of T lymphocyte subsets(CD3^(+),CD4^(+))and NK cells were lower in allogeneic transfusion group[(62.66±7.96)%,(31.03±6.50)%,(6.98±2.03)%]by day 7 after operation than those in non-transfusion group[(69.83±9.23)%,(37.03±8.80)%,(8.98±2.89)%]and autologous transfusion group[(68.98±7.05)%,(36.50±6.25)%,(8.50±2.56)%](P<0.05);and the percentage of CD8^(+)T lymphocytes was higher in allogeneic transfusion group[(30.93±6.26)%]than that in non-transfusion group[(25.06±9.03)%]and autologous transfusion group[(25.26±6.62)%](P<0.05).There were no significant differences in the percentages of T lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+))and NK cells by day 7 after operation between non-transfusion group and autologous transfusion group(P>0.05).There were no significant differences in the 1-and 2-year overall survival rates among non-transfusion group(43.1%,30.8%);autologous transfusion group(33.3%,20.0%)and allogeneic transfusion group(32.0%,20.0%)(χ^(2)=1.171,P=0.557;χ^(2)=1.179,P=0.480).Conclusion Perioperative allogeneic transfusion would damage the early postoperative immune function of patients with hilar cholangiocarcinoma,but it has no significant impact on the long-term survival of patients.