自体血液回输对脊柱手术患者术后IL-6、IFN-γ和TNF-α的影响

目的观察同种异体输血和自体血液回输对脊柱手术患者术后免疫反应的影响。方法择期行脊柱手术的患者44例,按手术日奇偶数分为2组,自体组术中仅输注自体洗涤红细胞（22例）,异体组术中仅输注异体悬浮红细胞（22例）,分别测定2组术前、术后1天和术后7天血清中白细胞介素6（IL-6）、干扰素γ（IFN-γ）和肿瘤坏死因子α（TNF—α）的水平。结果与术前相比,自体组术后1天、7天血清IFN-γ和IL-6均增高,IL-6升高尤为显著,明显高于异体组,2组间差异有显著性（P〈0.01）。2组术后的TNF—α水平在各个时间点都没有明显变化。结论与同种异体输血相比,在脊柱手术中采用自体血液回输对术后患者血清中TNF-α的影响不明显,但可以明显提高IFN-γ和IL-6的水平。自体血液回输对术后免疫细胞因子的抑制作用远小于异体输血,能够保护甚至增强脊柱手术患者术后的细胞免疫功能。

Effect of Autologous Blood Transfusion on Postoperative Levels of IL-6,IFN-γ,and TNF-α after Spinal Operation

Objective To compare the effect of allogeneic and autologous blood transfusion on postoperative immunoreaction in patients after spinal surgeries. Methods A total of 44 patients undergoing spinal operations were randomly divided into two groups. Allogeneic （n =22） or autologous （n =22） bully-coat-depleted red cells were used in the patients during the operations. The serum levels of IL-6, IFN-γ, and TNF-α were determined preoperatively and then re-measured 1 and 7 days after the operations. Results In theautologous group, both IFN-γ and IL-6 increased after the oprerations, the level of IL-6 was significantly higher than that in the allogeneic group at days 1 and 7. The concentration of TNF-α did not change after the surgeries in the two groups. Conclusions By autologous blood transfusion, the serum levels of IFN-γ and IL-6 can be increased significantly after spinal operation, meanwhile the concentration of TNF-α remains stable. The postoperative inhibitory effect of the procedure on immunocytokines is significantly weaker than that of allogeneic blood transfusion, indicating that autologous blood transfuion can protect or even increase immunofunction after spinal operation.