白细胞过滤对血小板保存期间炎性细胞因子水平的影响及临床效果的评估  

Changes of inflammatory cytokines in leukocyte-depleted PCs and decreased FNHTR by leukoreduced PCs transfusion

作　　者：成晓玲[1] 赵树铭[1] 胡建[1] 曾杰[1] 任德惠[1] 王泽荣[1] 林武存[1] 

机构地区：[1]西南医院,重庆400038

出　　处：《中国输血杂志》2002年第3期156-159,共4页Chinese Journal of Blood Transfusion

摘　　要：目的　考察浓缩血小板悬液 (plateletconcentratesuspend ,PCs)在保存期内IL 1β、IL 6、IL 8和TNF α的浓度变化和过滤对其的影响 ,了解在保存前滤除PCs中的白细胞是否能有效地减少这些细胞因子的积累和降低受血者非溶血性发热性输血反应 (febrilenonhemolytictransfusionreactions,FNHTR)发生率。 方法　将 1单位PCs分成两等份 ,分别给予血小板专用白细胞滤器过滤处理和不滤除白细胞处理 ,保存 5d。在 0、3、5d测定IL 1β、IL 6、IL 8和TNF α含量及白细胞计数 ,采用配对t检验进行统计分析 ;临床观察未滤组和过滤组PCs输后FNHTR发生率。结果　PCs中的白细胞计数与保存 5d时IL 1β、IL 6、IL 8和TNF α水平之间呈正相关。未滤组PCs中有较多白细胞混入 [(35 1± 81)× 10 6/袋 ],在保存期间IL 1β、IL 6、IL 8和TNF α水平明显升高 ;过滤组的PCs残余白细胞 <1× 10 6/袋在保存期间诸细胞因子均保持在 0d水平 ;临床观察显示 ,末滤PCs与过滤PCs输注后FNHTR发生率分别为 2 0 .83%和 5 .83% ,P <0 .0 1。结论　保存前用血小板专用去白细胞滤器去除PCs中残留的白细胞能有效地防止细胞因子的积累 ,同时保留 95 %以上的血小板。Objective To investigate the changes of leukocyte derived cytokines,IL 1β,IL 6,IL 8,and TNF α,in platelets concentrates (PCs) during storage,and to study the effect of leukodepletion on cytokine concentration in PCs and the incidence rate of febrile non hemolytic transfusion reaction (FNHTR).Methods 8 bags of apheresed PCs from 8 voluntary donors were each divided into two identical portions (A and B).Group A underwent leukocyte filtration,while group B did not.Then both groups were stored at 22℃ for 5 days.The levels of cytokines (pg/ml),white blood cell (WBC) count and platelet count in both groups were tested on the day 0,3 and 5 during storage.In clinic,240 patients were randomly divided into two groups with 120 in each group to receive non filtered or filtered PCs (1 bag/patient).The incidence of FNHTR was investigated.Paired t test and χ 2 test were used in data analysis. Results There was a significant positive correlation between the content of WBC in PCs and the level of cytokines.On the 5th day of storage,residual WBC in leukoreduced PCs were less than 1×10 6/PC,the levels of cytokines remained the same as those on 0;however,WBC in non filtered PCs was (351±81)×10 6/PC,and the levels of IL 1β?IL 6?IL 8 and TNF α were 105.0pg/ml,269.0pg/ml,1840pg/ml and 42.0pg/ml respectively and increased 18 ( P< 0.001),67 (P< 0.001),90 (P< 0.001) and 5 ( P < 0.05) folds respectively,compared with day 0.Incidence of FNHTR was 5.83% in patients receiving filtered PCs and 20.83% in those receiving non filtered PCs ( P < 0.01). Conclusion Leukocyte depleted PCs can effectively prevent accumulation of inflammation cytokines and decrease the incidence of FNHTR.

关 键 词：白细胞过滤 炎性细胞因子 输血反应 非溶血性发热性 血小板悬液 FNHTR 

分 类 号：R457.13[医药卫生—治疗学] R331.142[医药卫生—临床医学]