Zhang Qi, Wu Huahui, Zhang Jingjun, Qi Qi, Zhang Wei, Xia Rong
Department of Blood Transfusion, Huashan Hospital, Fudan University, Shanghai, China.
Harbin Hospital of Traditional Chinese Medicine, Harbin, Heilongjiang, China.
J Cancer. 2019 Jun 9;10(15):3526-3532. doi: 10.7150/jca.28953. eCollection 2019.
Immunosuppression induced by transfusion causes postoperative adverse events including poor prognosis in cancer, but data on influence of the immune response on blood transfusion requirements during perioperative period are limited. The aim of this study was to investigate whether the preoperative immune response is associated with perioperative blood cell transfusion in a glioma surgical patient population. The authors identified 321 cases of surgery for treatment of glioma. Patient variables, preoperative laboratory variables (hemoglobin, platelet count, activated partial thromboplastin time, prothrombin time, hematocrit, red and white blood cell count), and transfusions were registered. Plasma concentration of Th-associated cytokines was measured by flow cytometry. Multivariable regression analysis and receiver operating characteristic curve were undertaken to identify predictors of transfusion. Of 321 patients, 157 (48.90%) received red blood cells transfusion. The mean age is significantly higher in transfusion group compared to no transfusion group, while postoperative hospital stay, preoperative hemoglobin, prothrombin time, activated partial thromboplastin time, platelet count, red and white blood cell count and hematocrit of patients did not differ significantly between the two groups. No significant differences of IL-2, -4, -6, -10 and INF-γ concentration were observed between transfusion and no transfusion group. The concentration of TNF and IL-17A was significantly lower in transfusion patients than in the no transfusion subjects. Low plasma TNF and IL-17A levels predicted high perioperative transfusion rate, the combination of them enlarged the prognostic accuracy of testing. Our study demonstrates that the preoperative immune response influences transfusion requirements, and TNF and IL-17 are important predictive risk factors for perioperative use of blood components in glioma patients.
输血引起的免疫抑制会导致术后不良事件，包括癌症患者预后不良，但围手术期免疫反应对输血需求影响的数据有限。本研究的目的是调查术前免疫反应是否与胶质瘤手术患者围手术期血细胞输血有关。作者确定了321例治疗胶质瘤的手术病例。记录患者变量、术前实验室变量（血红蛋白、血小板计数、活化部分凝血活酶时间、凝血酶原时间、血细胞比容、红细胞和白细胞计数）以及输血情况。通过流式细胞术测量与Th相关的细胞因子的血浆浓度。进行多变量回归分析和受试者工作特征曲线分析以确定输血的预测因素。在321例患者中，157例（48.90%）接受了红细胞输血。输血组的平均年龄显著高于未输血组，而两组患者的术后住院时间、术前血红蛋白、凝血酶原时间、活化部分凝血活酶时间、血小板计数、红细胞和白细胞计数以及血细胞比容无显著差异。输血组和未输血组之间未观察到IL-2、-4、-6、-10和INF-γ浓度的显著差异。输血患者的TNF和IL-17A浓度显著低于未输血患者。低血浆TNF和IL-17A水平预示着围手术期输血率高，它们的组合提高了检测的预后准确性。我们的研究表明，术前免疫反应会影响输血需求，TNF和IL-17是胶质瘤患者围手术期使用血液成分的重要预测风险因素。
