小剂量高渗氯化钠羟乙基淀粉40对自然杀伤细胞和血小板CD41的影响

目的 观察术中高渗氯化钠羟乙摹淀粉40注射液(HSS40)对恶性肿瘤患者体内自然杀伤细胞(NK细胞)和血小板活化分子CD41影响.方法 将76例手术患者随机分两组:输血组(A组)38例、HSS40组(B组)38例.于麻醉前1 h、术后1、3、7 d抽取外周血,细胞检测仪检测CD56和CD41含量;以乳酸脱氢酶释放法检测NK细胞活性.结果 组间比较:CD56术后第3、7天B组高于A组,差异显著(25.560±11.026比15.648±6.729;29.040±10.221比15.035±6.758,P<0.01),NK细胞活性术后第7天两组比较差异有统计学意义(19.939±6.994比15.307±5.107,P<0.05);CD4,术后l d B组明显低于A组(7.740 4-4.101比10.752 4-5.493,P<0.01).组内比较:A组术后第3天NK细胞活性下降(P<0.05),术后第7天下降明显,与术前比较差异有统计学意义(P<0.01),B组术后第7天NK细胞活性与术前比较差异有统计学意义(P<0.05),CD56术后第3天有所上升(P<0.05),术后第7天上升明显,与术前比较差异有统计学意义(P<0.01).两组CD41术后1～7 d均明显高于术前水平(P<0.01).结论 手术和输血可导致术后NK细胞活性降低,血小板CD41含量明显升高,术中输注HSS40,术后NK细胞活性及数目不同程度升高,且降低血小板CD41含量.

The Effect of small dose of hypertonic sodium chloride hydroxyethyl starch 40 infusion during surgery on NK cells and CD41 content

Objective To study the effect of small dose of hypertonic sodium chloride hydroxyethyl starch 40 infusion during cancer surgery on NK cells and CD41 content. Methods Seventy-six patients who underwent malignant tumor resection were randomly divided into two groups. In group A, 38 patients were treated with packed red cells, and in group B, 38 patients received hypertonic sodium chloride hydroxyethyl starch 40 infusion during surgery. The blood samples were collected 1 h before anesthesia and on the first, 3rd, 7th day after operation. The contents of CD56 and CD41 were measured by flow eytometry (FCM) , and the method of LDH release was used to determine the cytotoxicity of NK cells. Results The content of CD56 in group A was higher than that in group B (P <0.01) , and that of CD41 at the first day after operation was obviously decreased in group A as compared with group B (P < 0.01). There was significant difference in the NK cytotoxicity between these two groups on the 7th day after operation. The NK cytotoxicity was markedly decreased on the 3rd and 7th day after operation as compared with that before anesthesia (P < 0. 05, P < 0.01). In group B, the NK cytotoxicity was lower only on the 7th day after operation (P < 0. 05), but the content of CD56 was increased on the 3rd and 7th day after operation (P < 0.05, P < 0.01);The postoperative CD41 content was kept at a higher level than baseline during whole procedures in both two groups ( P < 0. 01). Conclusion Blood transfusion during surgery in cancer patients leads to the decrease of NK cyotoxicity after operation, while small dose of hypertonic sodium chloride hydroxyethyl starch 40 infusion can increase the amount of NK cells and the cyotoxicity of NK cells, and may be helpful in reducing CD41 content in peripheral platelets.