ANIH对肿瘤患者围术期T淋巴细胞亚群和NK细胞的影响

目的探讨急性非等容量血液稀释（ANIH）对肿瘤患者围术期T淋巴细胞亚群及NK细胞的影响。方法将择期行直肠癌根治术（Mile’s）患者60例,随机分为3组,每组20例：Ⅰ组（不输血组）,Ⅱ组（输异体少白细胞红细胞组）,Ⅲ组（ANIH组）。于麻醉诱导前采血400～600ml,全麻诱导时快速输入2倍采血量的羟乙基淀粉,并于手术结束前或Hct﹤24%时将自体血予以回输。分别于麻醉前1h（T1）、术毕即刻（T2）、术后第1d（T3）、第4d（T4）抽取静脉血,测定T淋巴细胞亚群和NK细胞。结果与正常人群比较,T1时三组CD3＋、CD4＋、CD4＋/CD8＋和NK细胞水平均低于正常值（P〈0.01）,CD8＋水平增高（P〈0.01）。与T1时比较,T3时CD3＋、CD4＋和CD4＋/CD8＋水平三组均明显降低（P〈0.05）,Ⅰ组和Ⅱ组降低较Ⅲ组更明显（P〈0.05）;Ⅰ组和Ⅱ组组间差异无统计学意义（P〉0.05）,T4时三组均恢复至T1时水平,但Ⅰ组和Ⅱ组CD3＋、CD4＋和NK细胞均值较Ⅲ组低（P〈0.05）。结论直肠癌患者术前存在细胞免疫功能的抑制,ANIH对免疫抑制轻微,且术后免疫功能恢复快。急性非等容量血液稀释可作为肿瘤患者围术期血液保护的良好措施。

Influence of Pre-operative Acute Non-isovolemic Hemodilution (ANIH) on Immunity of T-lymphocyte Subsets and Natural Kill Cell in Cancer Patients During Pperioperative Period

Objective To investigate the influence of pre-operative acute non-isovolemic hemodilution（ANIH） on immunity of T-lymphocyte subsets and natural kill cell in cancer patients during perioperative period.Methods 60 ASA ⅠorⅡpatients scheduled for elective rectal cancer surgery were randomly divided into three groups（n = 20）：group Ⅰ：no transfusin group,group Ⅱ：white cell-reduced allogenic red blood cell transfusion group,group Ⅲ：ANIH group.Before induction of anesthesia,400-600 ml blood was obtained from patients.During anesthesia induction,2 times volume of the taken blood of hydroxyethyl starch was qicky transfused,and at the end of surgery or Hct 24%,the autoblood was transfused.Venous blood samples were taken before surgery（T1）,immediately after surgery（T2）,on the 1st（T3） and 4th（T4） postoperative day for determination of T-lymphocyte subsets and natural kill cell.Results The three groups were comparable regard to sex,types of operation,TNM stage,intraoperative blood loss and the mean duration of operation.Compared with normal value,the values of CD3 ＋,CD4 ＋,CD8 ＋ counts and CD4 ＋ /CD8 ＋ ratio and NK cell were significantly decreased（P 0.01）,but without significant difference in three groups.CD3 ＋,CD4 ＋ counts,CD4 ＋ /CD8 ＋ ratio and NK cells decreased significantly in T3 in all groups（P 0.05 or 0.01）,but the decrease was more pronounced in groupⅠand Ⅱ.On T4,CD3 ＋,CD4 ＋ counts,CD4 ＋ /CD8 ＋ ratio and NK cell returned to T1 level in all groups but CD3 ＋,CD4 ＋ counts in group Ⅰand group Ⅱ remain lower than that in group Ⅲ（P 0.05）.Couclusion The immunity of cancer patients were suppressed before operation.The Influence of pre-operative acute nonisovolemic hemodilution（ANIH） on immunity are milder and the recovery is rapid.ANIH can be elected as blood conservation in cancer patients during perioperative period.