Dalén T, Bengtsson A, Brorsson B, Engström K G
Department of Surgical and Perioperative Science, Umeå University Hospital, Sweden.
Vox Sang. 2003 Jul;85(1):31-9. doi: 10.1046/j.1423-0410.2003.00314.x.
The aim of this study was to evaluate whether leucocyte-reducing filters influenced complement activation and the formation of pro-inflammatory cytokines in autotransfusion drain blood after knee arthroplasty.
Twenty-three patients undergoing knee arthroplasty were divided into two groups. All patients were given salvage blood postoperatively. In Group A, a leucocyte filter was connected between the wound and the drain blood container. In Group B the drain blood was not leucocyte filtered. Complement split products and cytokines were analysed in circulating blood and in drain blood, together with blood-cellular differential counts.
Drain blood showed activation vs. venous blood, with elevated concentrations of C3a, SC5b-9, interleukin (IL)-6, IL-8, polymorphonuclear (PMN) elastase and tumour necrosis factor-alpha (TNF-alpha) (P<0.05 to P<0.001). The leucocyte filter reduced TNF-alpha (P<0.01), but triggered complement activation (P<0.05). Room-temperature incubation increased the concentration of IL-8 (P<0.01), which was seen in both venous and drain blood. The leucocyte filter prevented formation of IL-8 (P<0.01). In drain blood at 24 h the inflammatory reactions accelerated (P<0.05-0.001), although the filter reduced the leucocyte counts and TNF-alpha concentrations.
The leucocyte filter reduced IL-8 and TNF-alpha in drain blood, but at the same time triggered complement activation. Incubation affected the inflammatory spectrum of both drain blood and control venous blood, and the filtering reduced this activation.
本研究旨在评估白细胞滤器是否会影响膝关节置换术后自体输血引流血中补体激活及促炎细胞因子的形成。
23例行膝关节置换术的患者被分为两组。所有患者术后均接受回收血。A组在伤口与引流血容器之间连接白细胞滤器。B组引流血未进行白细胞过滤。分析循环血和引流血中的补体裂解产物、细胞因子以及血细胞分类计数。
与静脉血相比，引流血出现激活现象，C3a、SC5b - 9、白细胞介素（IL）- 6、IL - 8、多形核（PMN）弹性蛋白酶和肿瘤坏死因子 - α（TNF - α）浓度升高（P < 0.05至P < 0.001）。白细胞滤器降低了TNF - α（P < 0.01），但引发了补体激活（P < 0.05）。室温孵育增加了IL - 8的浓度（P < 0.01），静脉血和引流血中均可见。白细胞滤器阻止了IL - 8的形成（P < 0.01）。在24小时时，尽管滤器降低了白细胞计数和TNF - α浓度，但引流血中的炎症反应加速（P < 0.05 - 0.001）。
白细胞滤器降低了引流血中的IL - 8和TNF - α，但同时引发了补体激活。孵育影响了引流血和对照静脉血的炎症谱，而过滤减少了这种激活。
