稀释式自体输血与少白细胞红细胞输注对肿瘤患者围术期T淋巴细胞亚群、NK细胞影响的比较

Comparative effect of white cell0reduced allogenic red blood cells versus autologous transfusion on T-lymphocyte subsets and natural killer cell during perioper ative period in cancer patients

目的 探讨输入异体全血、异体少白细胞红细胞和等容血液稀释自体输血对围术期 T淋巴细胞亚群、NK细胞的影响。方法 选择胃癌、结肠癌或直肠癌根治手术患者 60例 ,随机均分为 3组。1H1组 :术中输异体全血 40 0～ 60 0 m l;2 H2 组 :术中输异体少白细胞红细胞 2～ 3单元 ;3 A组 :于麻醉后手术切皮前经桡动脉放血 40 0～ 60 0 ml,同时经静脉输入相当容量的羟乙基淀粉 ,手术后半阶段将自体血回输。分别于术前、手术后即刻、术后 1天、术后 5天抽取静脉血 ,用流式细胞仪测定 T细胞亚群和 NK细胞的数量。结果 三组术后第 1天 CD3、CD4、 CD4/ CD8、 NK细胞较术前显著减少 (P <0 .0 5或 P <0 .0 1) ,其中 H1组和 H2 组较 A组减少更明显 (P <0 .0 5)。术后第 5天异体输血组 CD3、 CD4、 CD4/ CD8、 NK细胞仍较术前显著减少 ,而 H2 组和 A组均基本恢复正常 ,且 A组 CD3、 CD4、高于 H2 组 (P <0 .0 5)。结论 围术期异体输血严重抑制患者免疫功能 ,少白细胞红细胞和等容血液稀释自体输血对患者的免疫功能抑制轻 ,且术后恢复较快 。

Objective To investigate the changes in counts of T0lymphocyte subsets and natural kill cell after perioperative allogenic who le0blood transfusion,white cell0reduced a llogenic red blood cells transfusion or autologous blood transfusion (acute hem odilution) Methods Sixty ASAⅠ～Ⅱpatient s undertaking electi ve radical rectal,colon or stomach cancer surgery were randomly divided into 3 groups: group H 1 received allogenic whol e0blood transfusion,group H 2 recei ved white cell0reduced allogenic red blood cell s transfusion and group A received autologo us transfusion After operation the patie nts were transferred to recovery room and pa tient controlled analgesia(PCA) was start ed when the patients were wide awake Veno us blood samples were taken before a nd immediately after surgery,on the 1st and 5th day postoperative for determina tion the counts of T0lymphocyte subsets and NK cells by Flow cytometry (EPICS0Elite USA) Results The CD 4 counts decre ased significantly at im mediately after surgery in both groups H 1 a nd H 2(P<0 05) The NK cell,CD 3 ,CD 4 counts and CD 4/CD 8 ratio decreased significantly on the 1st day after opera t ion in all groups(P<0 05 or P<0 01),bu t the decrease was more pronounced in bo th groups H 1 and H 2 On the 5th day postoperative,the NK ce ll,CD 3,CD 4 counts and CD 4/CD 8 radio r etu ned to preoperative level in both groups H 2 and A but remained low in group H 1 Conclusion P erioperative transfusions have serio us and prolonged inhibition effects on pat ient's immune functuion In both auto logous blood and white cell0reduced alloge nic red blood cells transfusion group s the changes are milder and the recovery i s more rap id as compared with those in allogenic tra nsfusion group