异体输血和自体输血对接受全髋关节置换术患者免疫功能的影响。

The effects of allogeneic and autologous blood transfusion on immune function in patients receiving total hip replacement.

作者信息

Han Zong-Zheng, Li Miao, Zhang Yong

机构信息

Graduate School of Jinzhou Medical University Jinzhou 121000, Liaoning, China.

Blood Transfusion Department, Hanchuan People's Hospital Hanchuan 431600, Hubei, China.

出版信息

Am J Transl Res. 2023 Jul 15;15(7):4709-4717. eCollection 2023.

PMID:37560247

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10408532/

Abstract

OBJECTIVE

To evaluate the effects of allogeneic and autologous blood transfusion on immune function and postoperative inflammation in patients after total hip replacement.

METHODS

In this retrospective study, the clinical data of 60 patients undergoing total hip arthroplasty through a posterolateral approach were analyzed. The patients were grouped into an autologous blood transfusion group (allo group) (n = 30) and an autologous blood transfusion group (auto-group) (n = 30) according to the treatment they received. All patients did not receive preoperative and intraoperative blood transfusion. The blood collected in the operation area was transfused to the patients in the auto-group with the autotransfusion device and the allogeneic blood was transfused to the patients in the allo-group after the operation. The average amount of blood transfusion was 400 ml. The immune function after blood transfusion was mainly evaluated by natural killer cell cytotoxicity (NKCC) and interleukin-2 (IL-2) using ELISA kits, meanwhile the changes of cellular immune factor levels (differentiation cluster of differentiation, CD) (CD3+, CD4+) and humoral immune factor levels (Immunoglobulin E, IgE) after blood transfusion were determined by flow cytometry. The secondary outcome was postoperative inflammatory response measured by white blood cell (WBC) count, neutrophil percentage (NP) and C-reactive protein (CRP).

RESULTS

The parameters of both groups of patients were comparable. The auto-group significantly outperformed the Allo-group in the following laboratory parameters: NKCC (%, E:T = 10:1) at day 2 [26.1 (Auto) vs 19.3 (Allo); = 0.0025], NKCC (%, E:T = 5:1) at day 2 [20.0 (Auto) vs 17.3 (Allo); = 0.0094], CD3+ (%) at day 2 [50.5 (Auto) vs 40.8 (Allo); = 0.0233], CD4+ (%) at day 2 [41.2 (Auto) vs 26.3 (Allo); = 0.0122], IgE (U/mL) at day 2 [157.8 (Auto) vs 319.8 (Allo); = 0.0064].

CONCLUSION

Autotransfusion can safely replace allogeneic blood transfusion and reduce the damage of postoperative immune function after total hip arthroplasty.

摘要

目的

评估同种异体输血和自体输血对全髋关节置换术后患者免疫功能及术后炎症的影响。

方法

在这项回顾性研究中，分析了60例经后外侧入路行全髋关节置换术患者的临床资料。根据患者接受的治疗方法，将其分为异体输血组（allo组）（n = 30）和自体输血组（auto组）（n = 30）。所有患者术前及术中均未输血。手术区域收集的血液通过自体输血装置输给auto组患者，术后将异体血输给allo组患者。平均输血量为400 ml。输血后的免疫功能主要采用ELISA试剂盒通过自然杀伤细胞细胞毒性（NKCC）和白细胞介素-2（IL-2）进行评估，同时采用流式细胞术测定输血后细胞免疫因子水平（分化簇，CD）（CD3 +、CD4 +）和体液免疫因子水平（免疫球蛋白E，IgE）的变化。次要结局指标是通过白细胞（WBC）计数、中性粒细胞百分比（NP）和C反应蛋白（CRP）来衡量术后炎症反应。

结果

两组患者的各项参数具有可比性。在以下实验室参数方面，auto组显著优于allo组：术后第2天NKCC（%，E:T = 10:1）[26.1（auto组）对19.3（allo组）；P = 0.0025]，术后第2天NKCC（%，E:T = 5:1）[20.0（auto组）对17.3（allo组）；P = 0.0094]，术后第2天CD3 +（%）[50.5（auto组）对40.8（allo组）；P = 0.0233]，术后第2天CD4 +（%）[41.2（auto组）对26.3（allo组）；P = 0.0122]，术后第2天IgE（U/mL）[157.8（auto组）对319.8（allo组）；P = 0.0064]。