Heiss M M, Fraunberger P, Delanoff C, Stets R, Allgayer H, Ströhlein M A, Tarabichi A, Faist E, Jauch K W, Schildberg F W
Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
Shock. 1997 Dec;8(6):402-8. doi: 10.1097/00024382-199712000-00002.
Even though blood transfusion-associated immunomodulatory effects have been reported, the basic immune mechanism is still not understood. Data from studies on the clinical effects of allogeneic blood-induced immunosuppression are contradictory. However, there are indications that autologous blood transfusion is not immunologically neutral but has intrinsic immunomodulatory potential. Therefore we investigated in vivo different immunological mediators in 56 randomized patients of a study comparing autologous and allogeneic blood transfusion in colorectal cancer surgery. Soluble IL-2 receptor, which is an indicator of general immune activation and the following immunologic refractory phase, indicated immunosuppression was more elevated at the seventh postoperative day in patients with allogeneic transfusions (p = .013) and autologous transfusions (p = .0003). The immunologic determination of TNF-alpha showed a significant postoperative increase in patients with autologous transfusions only (p = .0031). However, postoperative increase of soluble TNF-receptors p55 and p75 was also significant in patients transfused with allogenic blood (p = .022; p = .0014). The response to tetanus toxoid vaccination, an indicator of humoral immunity, was higher in patients transfused with allogeneic rather than autologous blood (p = .082), whereas responses of patients with autologous transfusions were even lower than in nontransfused patients. The reciprocal was already found for cell-mediated immunity determined by epicutaneously tested delayed-type hypersensitivity-reactions. IL-10 levels, an indicator of cellular immunosuppression, were determined in 27 additional patients before operation, immediately postoperative, and at the seventh postoperative day. IL-10 was found elevated immediately postoperative in allogeneic (p = .011) and nontransfused patients only (p = .042). The data from this study substantiate recent findings of a different immunomodulatory potential of allogeneic and autologous blood transfusion. They furthermore support the hypothesis that autologous blood transfusion does not contain immunologically neutral effects of allogeneic blood, but itself exerts an immunomodulatory effect.
尽管已有输血相关免疫调节作用的报道，但基本免疫机制仍不清楚。关于异体输血诱导免疫抑制临床效应的研究数据相互矛盾。然而，有迹象表明自体输血并非免疫中性，而是具有内在免疫调节潜能。因此，我们在一项比较结直肠癌手术中自体输血和异体输血的研究中，对56例随机分组的患者体内不同免疫介质进行了研究。可溶性白细胞介素-2受体是一般免疫激活及随后免疫不应期的指标，结果显示异体输血患者（p = 0.013）和自体输血患者（p = 0.0003）在术后第7天免疫抑制更为明显。仅自体输血患者肿瘤坏死因子-α的免疫学测定显示术后显著升高（p = 0.0031）。然而，接受异体输血患者术后可溶性肿瘤坏死因子受体p55和p75也显著升高（p = 0.022；p = 0.0014）。破伤风类毒素疫苗接种反应是体液免疫的指标，接受异体输血患者的反应高于自体输血患者（p = 0.082），而自体输血患者的反应甚至低于未输血患者。对于通过皮内试验迟发型超敏反应测定的细胞介导免疫，结果则相反。另外27例患者在术前、术后即刻及术后第7天测定了白细胞介素-10水平，白细胞介素-10是细胞免疫抑制的指标。结果发现仅异体输血患者（p = 0.011）和未输血患者（p = 0.042）在术后即刻白细胞介素-10升高。本研究数据证实了异体输血和自体输血具有不同免疫调节潜能的最新发现。它们还支持这样的假说，即自体输血不存在异体输血的免疫中性效应，而是自身发挥免疫调节作用。
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