等容稀释性自体输血对孕产妇免疫功能的影响  

Effects of normovolemic hemodilution autologous blood transfusion on immune function of pregnant women

作　　者：黄耘祥[1] 黄荣[2] 

机构地区：[1]孝感市中心医院输血科,湖北孝感432000 [2]孝感市中心医院外科

出　　处：《临床血液学杂志（输血与检验）》2015年第1期107-109,共3页Journal of Clinical Hematology(Blood Transfusion & Laboratory Medicine)

基　　金：湖北省卫计委2013-2014年度科研项目(No:JX6C-56)

摘　　要：目的：本文旨在对行剖宫产术的孕产妇进行等容稀释性自体输血（ANH）初期研究的基础上,探讨异体输血及ANH对行剖宫产术的孕产妇免疫功能的影响差异。方法：选择待进行剖宫产术分娩的孕产妇50例,随机分为2组。ANH组（Ⅰ组）：于麻醉后手术切皮前经桡动脉放血400~600ml,同时经静脉输入等容量的扩容液,产后或产程即将结束时将自体血回输。异体输血组（Ⅱ组）：剖宫产术中据情况给予异体悬浮红细胞2~3单位。分别于产前、产后第1、5天抽取静脉血,用流式细胞仪测定外周血中自然杀伤细胞（NK）、巨噬细胞、IL系列因子、IgG、IgM、CD3＋、CD4＋、CD4＋/CD8＋的变化情况。结果：12组产后1天CD3＋、CD4＋、CD4＋/CD8＋较产前显著减少,其中Ⅱ组较Ⅰ组减少更明显,NK细胞升高,P〈0.05。产后5天Ⅱ组CD3＋、CD4＋、CD4＋/CD8＋仍较产前显著减少,而Ⅰ组均基本恢复正常,且Ⅰ组CD3＋、CD4＋、高于Ⅱ组,P〈0.05。2产后1天IgA、lgG 2组均减少,IL-6、IL-8、TNF-a 2组均升高,差异有统计学意义（P〈0.05）;产后5天Ⅰ组均基本恢复正常,Ⅱ组与产前相比,2组差异有统计学意义（P〈0.05）;IgM 2组变化不显著,差异无统计学意义（P〉0.05）。结论：12组产后1天CD3＋、CD4＋、CD4＋/CD8＋较产前显著减少,其中Ⅱ组较Ⅰ组减少更明显,NK细胞升高,P〈0.05。产后5天Ⅱ组CD3＋、CD4＋、CD4＋/CD8＋仍较产前显著减少,而Ⅰ组均基本恢复正常,且Ⅰ组CD3＋、CD4＋、高于Ⅱ组,P〈0.05。2产后1天IgA、lgG 2组均减少,IL-6、IL-8、TNF-a 2组均升高,差异有统计学意义（P〈0.05）;产后5天Ⅰ组均基本恢复正常,Ⅱ组与产前相比,2组差异有统计学意义（P〈0.05）;IgM 2组变化不显著,差异无统计学意义（P〉0.05）。Objective：To investigate the difference of effect between allogeneic blood transfusion and normovolemic hemodilution autologous blood transfusion（ANH）on the immune function of pregnant women on the basis of our early research on ANH in the pregnant women received cesarean section.Method：50pregnant women to be cesarean section were randomly divided into two groups.ANH group（groupⅠ）：Anesthesia before surgery incision after transradial bloodletting 400-600 ml,while input the same volume expansion fluid intravenously,postpartum or near the end of the birth process do autologous blood transfusion.Allogeneic blood transfusion group（Ⅱ group）：According to situation during the cesarean section,2to 3units of allogeneic red blood cell suspension were transfused.Respectively,in prenatal and postnatal 1day,5day,natural killer（NK）cells,macrophages,IL series factors,IgG,IgM,CD3＋,CD4＋,and CD4＋/CD8＋in peripheral blood were measured by flow cytometry.Result：1 CD3＋,CD4＋and CD4＋/CD8＋at postnatal 1dof the two groups significantly reduced compared with prenatal,and the decrease of groupⅡ was more obvious compared with groupⅠ.NK cells increased,P〈0.05.CD3＋,CD4＋and CD4＋/CD8＋at postnatal 5day of group Ⅱ still significantly reduced compared to prenatal,whileⅠ group were returned to normal,and CD3＋and CD4＋of groupⅠ were higher than those of groupⅡ,P〈0.05.2IgA and lgG at postnatal 1dof the two groups were reduced,wihle IL 6,IL 8and TNF-a increased,which the differences were significant,P〈0.05.These indexes at postnatal 5day were returned to normal in group Ⅰ,Ⅱ group compared with before,the differences were significant,P〈0.05.IgM of the two groups did not change significantly,which the difference was not statistically significant,P〉0.05.Conclusion：Autotransfusion would have little effect on maternal immune function and have no significant inhibitory effect on the cellular immune function,while allogeneic blood transfusion would have obvious suppression eff

关 键 词：等容稀释 自体输血 孕产妇 免疫功能 

分 类 号：R457.1[医药卫生—治疗学]