围手术期异体输血对胃癌病人T细胞亚群的影响

目的 :研究围手术期异体输血对胃癌病人外周血T细胞亚群水平的影响 ,为临床合理输血提供理论依据。方法 :胃癌根治手术患者 3 0例 ,随机分为A、B、C 3组 ,每组各 10例 :A组围术期不输血 ,B组围术期输入去白细胞的全血 ,C组围术期输异体全血。另选 10例健康人作为对照。分别于手术前、术后 2d、术后 5d、术后 10d外周静脉采血 ,用流式细胞仪测定T细胞亚群的表达。结果 :3组胃癌病人术前T细胞亚群的水平要低于正常人水平。手术可以造成T细胞水平下降 ,术后 10d恢复正常。B、C组术后第 2天CD3、CD4表达开始减少 ,以CD4减少为主 ,CD4+ CD8+ 之值下降 ,与术前比较有显著差异 ,至术后10d仍未恢复正常。组间比较B组术后 2、5、10d与A组比较有显著差异 (P <0 .0 5 ) ,C组与A、B组比较术后 2、5、10dCD3 + 、CD4+ 表达下降 ,CD4+ CD8+ 之值下降显著 (P <0 .0 5 )。结论 :围手术期异体输血可造成免疫抑制 ,输全血比输去白细胞的全血更明显 ;围手术期成分输血优于输注全血 ;T细胞亚群在输血后的免疫调节中起重要作用。

Influences of perioperative allogeneic transfusion on T-lymphocyte subsets in gastric carcinoma patients

Objective To study effects of allogeneic blood transfusion on T-lymphocyte subset counts in gastric carcinoma patients. Methods Thirty patients undergoing resection for gastric carcinoma,were randomly divided into three groups with 10 case each. Group A patients received no blood,Group B patients were transfused with leukodepleted blood and Group C patients were allocated to receiving allogeneic whole blood during perioperative period. Blood samples were taken before operation,on 2nd-,5th- and 10th day after operation. T-lymphocyte subsets were estimated by flow cytometry. Results The T-lymphocyte subset counts was lower in gastric carcinoma patients than in normal controls(P<0.05). The CD3+ and CD4+ counts and CD4+/CD8+ ratio decreased after operation, but returned to the baseline levels on the 10th postoperative day. The CD3+ and CD4+ counts and CD4+/CD8+ ratio decreased significantly after operation in group B and group C, but not returned to preoperative level on the 10th postoperative day(P<0.05). As compared with that in group A, the CD3+ and CD4+ counts and CD4+/CD8+ ratio decreased markedly in group C than in group B (P<0.05). Conclusion Perioperative blood transfusion contributes to the immunosuppression, which is more serious after whole blood transfusion than leukodepleted blood transfusion. In perioperative period component blood transfusion is superior to whole blood transfusion. The decrease of the CD3+ and CD4+ counts and CD4+/CD8+ ratio may be one of the causes of immunosuppression in patients exposed to allogeneic blood transfusion.