Critical Care Division, Preventive Medicine and Health Public, University of Seville, Seville, Spain.
J Cardiothorac Vasc Anesth. 2009 Jun;23(3):330-5. doi: 10.1053/j.jvca.2008.09.015. Epub 2008 Dec 10.
The purpose of this study was to evaluate the influence of preoperative type I and II immune responses on blood transfusion requirements.
A prospective and observational trial.
A postcardiac surgery unit of a university hospital.
Seventy-one consecutive patients undergoing elective cardiac surgery.
Blood samples drawn for laboratory analysis and immunologic study.
Patients were divided into 2 groups according to blood transfusion requirements: < or = 2 units (n = 35) and >2 units of red blood cells (n = 36). The preoperative immune response was assessed by flow cytometry, measuring the proportion of CD4+ T helper cells producing cytokines, including Th1 response (interferon-gamma and tumor necrosis factor-alpha [TNF-alpha]) and Th2 response (interleukin 4 and 10). Two logistic regression analyses (including and not including immunologic variables) were used to select and weight perioperative variables associated with an increased risk of transfusion. Three variables were found to be independent predictors of transfusion requirements when immunologic variables were not included: preoperative platelet count, preoperative hemoglobin, and hypertension. When all the variables were included, preoperative hemoglobin, cardiopulmonary bypass time, and the preoperative proportion of CD4+ T cells producing TNF-alpha were associated with an increased risk of transfusion (Hosmer-Lemeshow, 0.33; c-index, 0.93), but preoperative platelet count and hypertension were not.
A low preoperative Th1 immune response, as assessed by the proportion of CD4+ T-helper-producing TNF-alpha, was associated with a higher blood transfusion rate.
本研究旨在评估术前Ⅰ型和Ⅱ型免疫反应对输血需求的影响。
前瞻性、观察性试验。
一所大学医院的心脏手术后病房。
连续 71 例行择期心脏手术的患者。
抽取血液样本进行实验室分析和免疫研究。
根据输血需求将患者分为两组：<或=2 单位（n=35）和>2 单位红细胞（n=36）。通过流式细胞术评估术前免疫反应，测量产生细胞因子的 CD4+辅助 T 细胞的比例，包括 Th1 反应（干扰素-γ和肿瘤坏死因子-α[TNF-α]）和 Th2 反应（白细胞介素 4 和 10）。采用 2 种逻辑回归分析（包括和不包括免疫变量），选择并加权与输血风险增加相关的围手术期变量。当不包括免疫变量时，有 3 个变量被发现是输血需求的独立预测因子：术前血小板计数、术前血红蛋白和高血压。当纳入所有变量时，术前血红蛋白、体外循环时间和术前产生 TNF-α的 CD4+T 细胞比例与输血风险增加相关（Hosmer-Lemeshow，0.33；c 指数，0.93），但术前血小板计数和高血压则不然。
术前 Th1 免疫反应（通过产生 TNF-α的 CD4+辅助 T 细胞的比例评估）较低与较高的输血率相关。
