Anaesthetics and Critical Care, Royal Infirmary of Edinburgh and the MRC Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom.
Transfusion. 2014 Oct;54(10):2404-11. doi: 10.1111/trf.12669. Epub 2014 May 5.
Transfused blood may have immunomodulatory and proinflammatory effects. We report the first randomized study exploring whether leukoreduced red blood cell (RBC) transfusion increases circulating proinflammatory mediators, markers of neutrophil activation, and the acute-phase response in critically ill adults.
Eighty-four patients were recruited from six general intensive care units in the United Kingdom as part of a laboratory study nested within a parallel-group randomized trial comparing restrictive and liberal leukoreduced RBC transfusion strategies in critically ill patients aged more than 55 years with measured hemoglobin concentrations of not more than 90 g/L (ClinicalTrials.gov NCT00944112). Forty-one patients received transfusion and 43 did not receive transfusion. Plasma was sampled at baseline, 6 hours, and 24 hours after randomization or transfusion, and concentrations of interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12-p70, interferon-γ, tumor necrosis factor-α, human neutrophil elastase, soluble L-selectin, and C-reactive protein were measured using cytokine bead array analysis and an enzyme-linked immunosorbent assay.
Patients who received transfusion did not have significantly different inflammatory biomarker plasma concentrations at the time points compared to those who did not receive transfusion, with the exception of IL-8 concentrations at 24 hours, which were reduced in the transfused group (p = 0.02). After adjustment for baseline inflammatory biomarker concentrations, there were no significant differences between patients who received transfusion and those who did not.
Concentrations of measured biomarkers were not significantly increased during the first 24 hours after leukoreduced RBC transfusion. These data do not support the contention that leukoreduced RBC transfusion is associated with a proinflammatory response in the general adult critically ill population.
输注的血液可能具有免疫调节和促炎作用。我们报告了第一项随机研究，该研究旨在探讨减少白细胞的红细胞（RBC）输血是否会增加循环中促炎介质、中性粒细胞活化标志物和急性相反应，在重症成人中。
84 名患者从英国六家普通重症监护病房招募，作为一项实验室研究的一部分，该研究嵌套在一项平行组随机试验中，该试验比较了年龄超过 55 岁且血红蛋白浓度测量值不超过 90g/L 的重症患者的限制性和宽松性减少白细胞的 RBC 输血策略（ClinicalTrials.gov NCT00944112）。41 名患者接受了输血，43 名患者未接受输血。在随机化或输血后 6 小时和 24 小时采集血浆，并使用细胞因子珠阵列分析和酶联免疫吸附试验测量白细胞介素（IL）-1β、IL-2、IL-4、IL-5、IL-6、IL-8、IL-10、IL-12-p70、干扰素-γ、肿瘤坏死因子-α、人中性粒细胞弹性蛋白酶、可溶性 L-选择素和 C 反应蛋白的浓度。
与未接受输血的患者相比，接受输血的患者在时间点上的炎症生物标志物血浆浓度没有显著差异，除了 24 小时时的 IL-8 浓度，在输血组中降低（p=0.02）。在调整基线炎症生物标志物浓度后，输血组和未输血组之间没有显著差异。
在减少白细胞的 RBC 输血后 24 小时内，测量的生物标志物浓度没有显著增加。这些数据不支持减少白细胞的 RBC 输血与普通成年重症患者群体中的促炎反应相关的论点。
