Triulzi D J, Blumberg N, Heal J M
Department of Pathology and Laboratory Medicine, Strong Memorial Hospital, University of Rochester Medical Center, NY.
Crit Rev Clin Lab Sci. 1990;28(2):95-107. doi: 10.3109/10408369009105899.
Homologous blood transfusion has been implicated as a modulator of the host immune system in a number of clinical settings. Improved renal allograft survival is observed in patients receiving pretransplant transfusions. Decreased recurrence of active inflammatory bowel disease has been recently reported in transfused patients with Crohn's disease. Conversely, deleterious immunomodulatory effects of transfusion may explain the association between transfusion and increased susceptibility to cancer recurrence and bacterial and viral infection. Clinical studies regarding cancer recurrence and transfusion are retrospective and conflicting. There is epidemiologic evidence for more rapid progression of HIV-1 infection in heavily transfused patients. Studies on transfused surgical patients have shown transfusion to be associated with an increased frequency of postoperative bacterial infections. Some studies have come to different conclusions. These investigators have suggested that transfusion may represent a surrogate marker for other risk factors for infection. Animal models designed to control for confounding factors have supported an association between transfusion and bacterial infection severity in most, but not all, reports. Attempts to define the immunologic alterations associated with transfusion have revealed a generalized impairment of cellular immunity in both humans and animals. Although the preponderance of data supports an association between perioperative transfusion and increased susceptibility to postoperative bacterial infection, it is not certain to what extent this relationship constitutes cause and effect.
在许多临床情况下，同源输血被认为是宿主免疫系统的调节因素。接受移植前输血的患者肾移植存活率有所提高。最近有报道称，患有克罗恩病的输血患者活动性炎症性肠病的复发率降低。相反，输血的有害免疫调节作用可能解释了输血与癌症复发以及细菌和病毒感染易感性增加之间的关联。关于癌症复发与输血的临床研究是回顾性的，且相互矛盾。有流行病学证据表明，大量输血的患者中HIV-1感染进展更快。对输血的外科手术患者的研究表明，输血与术后细菌感染频率增加有关。一些研究得出了不同的结论。这些研究人员认为，输血可能是其他感染风险因素的替代指标。旨在控制混杂因素的动物模型在大多数（但不是全部）报告中支持了输血与细菌感染严重程度之间的关联。试图确定与输血相关的免疫改变已揭示出人类和动物的细胞免疫普遍受损。尽管大量数据支持围手术期输血与术后细菌感染易感性增加之间存在关联，但尚不确定这种关系在多大程度上构成因果关系。
