Vamvakas Eleftherios C
Department of Pathology, New York University School of Medicine, New York, NY, USA.
Transfus Med Rev. 2002 Oct;16(4):304-14. doi: 10.1053/tmrv.2002.35209.
Previous meta-analyses of the randomized controlled trials (RCTs) investigating the association of perioperative allogeneic blood transfusion (ABT) with postoperative bacterial infection included studies transfusing either autologous or white blood cell (WBC)-reduced allogeneic red blood cells (RBCs) or whole blood to the control arm, and they were unable to investigate the type of RBC product administered as an explanation for the disagreements among the studies. The availability of additional RCTs has permitted investigation of this hypothesis in a meta-analysis restricted to RCTs transfusing WBC-reduced allogeneic RBCs or whole blood to the control arm. In this analysis, across 5 RCTs comparing recipients of non-WBC-reduced versus WBC-reduced allogeneic RBCs, there was no difference (P > .25) in the risk of postoperative infection between recipients of buffy-coat-reduced versus WBC-reduced allogeneic RBCs filtered before storage (summary odds ratio [OR] = 1.19; 95% confidence interval [CI], 0.87-1.63). In contrast, across 3 RCTs, there was an increased (P < .05) risk of postoperative infection in recipients of non-buffy-coat-reduced allogeneic RBCs, or whole blood, as compared with recipients of WBC-reduced allogeneic RBCs, or whole blood, filtered before or after storage (summary OR = 1.77; 95% CI, 1.02-3.09). Moreover, across 3 RCTs that enrolled patients undergoing open-heart surgery, there was an increased (P < .05) risk of postoperative infection in recipients of buffy-coat-reduced (compared with WBC-reduced) allogeneic RBCs (summary OR = 1.39; 95% CI, 1.08-1.80), but the findings of 5 RCTs that enrolled patients having abdominal surgery could not be combined because of extreme variation in the results of the studies. RCTs conducted in the setting of open-heart surgery or transfusing non-buffy-coat-reduced RBCs or whole blood to the treatment arm had administered various RBC products to the control arm, however, and thus the medical heterogeneity of the studies precludes any conclusion about an immunomodulatory (TRIM) effect of ABT mediated by non-buffy-coat-reduced RBC products. To determine whether such a deleterious immunomodulatory effect of ABT exists, additional RCTs transfusing non-buffy-coat-reduced RBCs to the treatment arm should be conducted.
既往对调查围手术期异体输血（ABT）与术后细菌感染相关性的随机对照试验（RCT）进行的荟萃分析纳入了在对照组输注自体血或白细胞（WBC）减少的异体红细胞（RBC）或全血的研究，并且它们无法探究作为研究间分歧原因的所输注RBC制品的类型。更多RCT的出现使得在一项仅限于在对照组输注WBC减少的异体RBC或全血的RCT的荟萃分析中能够对这一假设进行研究。在这项分析中，在5项比较未减少WBC的异体RBC接受者与减少WBC的异体RBC接受者的RCT中，减少血沉棕黄层的异体RBC接受者与储存前过滤的减少WBC的异体RBC接受者之间术后感染风险无差异（P>.25）（汇总比值比[OR]=1.19；95%置信区间[CI]，0.87 - 1.63）。相比之下，在3项RCT中，与储存前或储存后过滤的减少WBC的异体RBC或全血接受者相比，未减少血沉棕黄层的异体RBC或全血接受者术后感染风险增加（P<.05）（汇总OR = 1.77；95%CI，1.02 - 3.09）。此外，在3项纳入接受心脏直视手术患者的RCT中，减少血沉棕黄层（与减少WBC相比）的异体RBC接受者术后感染风险增加（P<.05）（汇总OR = 1.39；95%CI，1.08 - 1.80），但由于研究结果差异极大，无法合并5项纳入接受腹部手术患者的RCT的结果。然而，在心脏直视手术背景下进行的RCT或在治疗组输注未减少血沉棕黄层的RBC或全血的RCT在对照组中输注了各种RBC制品，因此研究的医学异质性排除了就未减少血沉棕黄层的RBC制品介导的ABT的免疫调节（TRIM）效应得出任何结论的可能性。为了确定ABT是否存在这种有害的免疫调节作用，应进行更多在治疗组输注未减少血沉棕黄层的RBC的RCT。
