两种输血方式对人工全膝关节置换术患者凝血功能、免疫功能及炎症因子的影响
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摘要
目的观察回收式自体输血技术与异体输血技术对人工全膝关节置换术患者凝血功能、免疫功能及炎症因子的影响。方法选择2016年8月至2017年8月在该院进行手术置换人工全膝关节的53例患者作为手术中回收式自体输血组(A组),选取60例患者作为异体血输入组(B组)。检测术后1d及5d的两组患者凝血功能指标、免疫功能及炎症因子血液指标,观察回收式自体输血技术与异体输血技术对人工全膝关节置换术患者凝血功能、免疫功能及炎症因子的影响。结果 A组患者术后1d与术后5d凝血功能指标值比较差异无统计学意义(P>0.05);两组患者的凝血功能指标值比较差异无统计学意义(P>0.05);A组CD3+CD4+T细胞、CD3+CD8+T细胞与CD16+CD56+NK细胞的含量均高于B组,差异具有统计学意义(P<0.01);A组术后1d与5dTLR2+细胞与TLR4+细胞检测结果低于B组,差异有统计学意义(P<0.01);A组术后1d与术后5d的可溶性CD40配体(sCD40L)、中性粒细胞趋化因子-1(CINC-1)、肿瘤坏死因子-α(TNF-α)与白介素-6(IL-6)的各项指标值均低于B组,差异有统计学意义(P<0.01)。结论术中回收式自体输血对人工全膝关节置换术患者凝血功能无显著影响,而且能够增强T细胞与NK细胞介导的机体免疫应答反应,同时抑制了TLR2及TLR4受体所介导的炎性反应,值得临床进一步研究推广应用。
Objective To observe the effect of salvaged autotransfusion technique and allogeneic transfusion on coagulation function,immune function and inflammatory factors in patients undergoing total knee arthroplasty.Methods 53 patients undergoing surgical total knee arthroplasty in the hospital from August 2016 to August 2017 were selected as the salvaged autotransfusion group(Group A)and 60 patients were selected as the allogeneic blood transfusion group(Group B).The blood coagulation parameters,immune function and blood index of inflammatory factors were measured on the 1 st and 5 th day after operation in order to observe the coagulation function,immune function and inflammatory factors in patients undergoing total knee arthroplasty using salvaged autotransfusion technique and allogeneic blood transfusion technique influences.Results There was no significant difference in coagulation function indexes between the 1 st postoperative day and5 th postoperative day in A group(P>0.05).There was no significant difference in the coagulation indexes between the two groups(P>0.05).The levels of CD3+CD4+T cells,CD3+CD8+T cells and CD16+CD56+NK cells in A group were significantly higher than those in B group,and the differences were statistically significant(P<0.01).The TLR2+cells and TLR4+cells in the A group 1 st and 5 th day after operation were lower than those in B group,and the differences were statistically significant(P<0.01).The values of soluble CD40 ligand(sCD40 L),cytokine-induced neutrophil chemoattractant 1(CINC-1),tumor necrosis factorα(TNF-α)and interleukin-6(IL-6)in A group were lower than those in B group on the 1 st and 5 th days after operation,and the differences were statistically significant(P<0.01).Conclusion The salvaged autotransfusion has no significant effect on the coagulation function of patients undergoing total knee arthroplasty,and it can enhance the immune response mediated by T cells and NK cells,and inhibite the inflammatory response mediated by TLR2 and TLR4 receptors,which deserves further research and application.
Objective To observe the effect of salvaged autotransfusion technique and allogeneic transfusion on coagulation function,immune function and inflammatory factors in patients undergoing total knee arthroplasty.Methods 53 patients undergoing surgical total knee arthroplasty in the hospital from August 2016 to August 2017 were selected as the salvaged autotransfusion group(Group A)and 60 patients were selected as the allogeneic blood transfusion group(Group B).The blood coagulation parameters,immune function and blood index of inflammatory factors were measured on the 1 st and 5 th day after operation in order to observe the coagulation function,immune function and inflammatory factors in patients undergoing total knee arthroplasty using salvaged autotransfusion technique and allogeneic blood transfusion technique influences.Results There was no significant difference in coagulation function indexes between the 1 st postoperative day and5 th postoperative day in A group(P>0.05).There was no significant difference in the coagulation indexes between the two groups(P>0.05).The levels of CD3+CD4+T cells,CD3+CD8+T cells and CD16+CD56+NK cells in A group were significantly higher than those in B group,and the differences were statistically significant(P<0.01).The TLR2+cells and TLR4+cells in the A group 1 st and 5 th day after operation were lower than those in B group,and the differences were statistically significant(P<0.01).The values of soluble CD40 ligand(sCD40 L),cytokine-induced neutrophil chemoattractant 1(CINC-1),tumor necrosis factorα(TNF-α)and interleukin-6(IL-6)in A group were lower than those in B group on the 1 st and 5 th days after operation,and the differences were statistically significant(P<0.01).Conclusion The salvaged autotransfusion has no significant effect on the coagulation function of patients undergoing total knee arthroplasty,and it can enhance the immune response mediated by T cells and NK cells,and inhibite the inflammatory response mediated by TLR2 and TLR4 receptors,which deserves further research and application.
引文
[1] HONG K H,PAN J K,XIE H,et al.Autologous blood transfusion drainage compared with no drainage in total knee arthroplasty:a meta-analysis and systematic review[J].Pak J Pharm Sci,2017,30(6):2321-2327.
[2] PAWASKAR A,SALUNKE A A,KEKATPURE A A,et al.Do autologous blood transfusion systems reduce allogeneic blood transfusion in total knee arthroplasty[J].Knee Surg Sports Traumatol Arthrosc,2017,25(9):2957-2966.
[3]周俊,张艳春.自体输血的应用探索与创新[J].中国输血杂志,2016,29(3):231-234.
[4]黄菲,吴昊,罗阳,等.自体输血方式的比较和自体成分血输注的研究进展[J].临床输血与检验,2016,18(2):193-196.
[5]容晓莹,郭向阳,曾鸿,等.术中回收式自体输血在产科患者中的应用[J].中国输血杂志,2017,30(1):94-98.
[6]张贤鹏,鲍海娥,杨蓉,等.自体输血与同种异体输血的临床效果研究[J].国际检验医学杂志,2015,36(9):1303-1305.
[7] GREENAWALT J A,ZERNELL D.Autologous blood transfusion for postpartum hemorrhage[J].MCN Am J Matern Child Nurs,2017,42(5):269-275.
[8]吴祥,周跃峰,童世杰,等.自体输血的成本效益分析[J].中国输血杂志,2013,26(4):395-398.
[9]陈飞,应伊丽,叶一冰,等.贮存式自体输血在髋关节置换术中的应用[J].中国输血杂志,2018,31(6):639-642.
[10]罗菲,梅燕.原花青素对急性痛风性关节炎大鼠TLR4/NF-κB信号通路的影响[J].中国临床药理学与治疗学,2018,23(1):41-46.
[11]曾雅静,叶惠芬,吴远军,等.回收式自体输血对产科手术患者血液流变学和凝血功能的影响[J].中国输血杂志,2016,29(2):159-161.
[12]纪雪红,韦爱芬,刘晓芬,等.颅脑手术治疗患者术中自体血液回输与异体输血对其临床疗效影响及感染研究[J].中华医院感染学杂志,2017,27(1):124-127.
[13]谢琦,林舟丹,张新华,等.等容稀释性自体输血对骨科老年手术病人凝血和免疫功能的影响[J].实用老年医学,2018,32(2):134-136.
[14]张鹏.预存式自体输血与术中回收式自体输血对择期手术患者机体免疫功能的影响研究[J].国际检验医学杂志,2017,38(23):3291-3293.
[15]QU Z,WANG G,XU G,et al.The effects of platelet apheresis on blood saving and coagulation in bilateral total hip replacement:A prospective study on 60patients[J].Int Surg.2016,34,58-63.
[16]严虹霞,杜娟,柴丽敏,等.不同免疫增强剂对肿瘤患者免疫功能的影响[J].中国医院药学杂志,2017,37(5):454-458.
[2] PAWASKAR A,SALUNKE A A,KEKATPURE A A,et al.Do autologous blood transfusion systems reduce allogeneic blood transfusion in total knee arthroplasty[J].Knee Surg Sports Traumatol Arthrosc,2017,25(9):2957-2966.
[3]周俊,张艳春.自体输血的应用探索与创新[J].中国输血杂志,2016,29(3):231-234.
[4]黄菲,吴昊,罗阳,等.自体输血方式的比较和自体成分血输注的研究进展[J].临床输血与检验,2016,18(2):193-196.
[5]容晓莹,郭向阳,曾鸿,等.术中回收式自体输血在产科患者中的应用[J].中国输血杂志,2017,30(1):94-98.
[6]张贤鹏,鲍海娥,杨蓉,等.自体输血与同种异体输血的临床效果研究[J].国际检验医学杂志,2015,36(9):1303-1305.
[7] GREENAWALT J A,ZERNELL D.Autologous blood transfusion for postpartum hemorrhage[J].MCN Am J Matern Child Nurs,2017,42(5):269-275.
[8]吴祥,周跃峰,童世杰,等.自体输血的成本效益分析[J].中国输血杂志,2013,26(4):395-398.
[9]陈飞,应伊丽,叶一冰,等.贮存式自体输血在髋关节置换术中的应用[J].中国输血杂志,2018,31(6):639-642.
[10]罗菲,梅燕.原花青素对急性痛风性关节炎大鼠TLR4/NF-κB信号通路的影响[J].中国临床药理学与治疗学,2018,23(1):41-46.
[11]曾雅静,叶惠芬,吴远军,等.回收式自体输血对产科手术患者血液流变学和凝血功能的影响[J].中国输血杂志,2016,29(2):159-161.
[12]纪雪红,韦爱芬,刘晓芬,等.颅脑手术治疗患者术中自体血液回输与异体输血对其临床疗效影响及感染研究[J].中华医院感染学杂志,2017,27(1):124-127.
[13]谢琦,林舟丹,张新华,等.等容稀释性自体输血对骨科老年手术病人凝血和免疫功能的影响[J].实用老年医学,2018,32(2):134-136.
[14]张鹏.预存式自体输血与术中回收式自体输血对择期手术患者机体免疫功能的影响研究[J].国际检验医学杂志,2017,38(23):3291-3293.
[15]QU Z,WANG G,XU G,et al.The effects of platelet apheresis on blood saving and coagulation in bilateral total hip replacement:A prospective study on 60patients[J].Int Surg.2016,34,58-63.
[16]严虹霞,杜娟,柴丽敏,等.不同免疫增强剂对肿瘤患者免疫功能的影响[J].中国医院药学杂志,2017,37(5):454-458.