辐照红细胞输注对围术期食管癌患者血清炎性因子水平及预后的影响

doi:10.3969/j.issn.1673-8640.2017.04.011

摘要/Abstract

摘要：

目的探讨食管癌患者围术期辐照红细胞输注对患者血清炎性因子水平及预后的影响。方法将159例行手术治疗的食管癌患者随机分为未辐照组（78例）和辐照组（81例）。未辐照组于术中输注异体悬浮红细胞,辐照组于术中输注¹³⁷Cs辐照25 Gy的异体悬浮红细胞。检测2组患者手术前后的白细胞介素（IL）-6、IL-10、肿瘤坏死因子α（TNF-α）及干扰素γ（IFN-γ）水平,并评价2组患者的预后情况。结果术后1和7 d,未辐照组IL-6、IL-10水平均显著高于术前（P<0.05）,且分别显著高于同期的辐照组（P<0.05）;未辐照组IFN-γ水平均显著低于术前（P<0.01）,且显著低于同期的辐照组（P<0.01）。术后1 d,未辐照组TNF-α水平显著低于术前（P<0.05）,且显著低于同期的辐照组（P<0.05）。术后1和7 d,辐照组上述指标水平与术前比较差异无统计学意义（P>0.05）。2组患者的住院时间、住重症监护病房（ICU）时间差异无统计学意义（P>0.05）。辐照组术后1年、3年、5年的生存率均显著高于未辐照组（P<0.05）。结论围术期输注辐照血的食管癌患者未引发免疫抑制且预后明显优于常规输血。但基于输血对患者预后影响的复杂性,仍需在控制其他因素的前提下,利用大样本的临床试验证实辐照输血对预后的积极影响。

关键词: 辐照红细胞输注, 炎性因子, 预后, 食管癌

Abstract:

Objective To evaluate the influence of red blood cell transfusion with radiation on serum inflammatory factors and prognosis of perioperative patients with esophageal carcinoma. Methods A total of 159 patients with esophageal carcinoma were enrolled. All patients were randomly classified into radiation-free group （78 cases）and radiation group （81 cases）. The radiation-free group was given variant suspended red blood cell. The radiation group was given variant suspended red blood cell with radiation （¹³⁷Cs,25 Gy）. The levels of interleukin （IL）-6,IL-10,tumor necrosis factor alpha（TNF-α）and interferon gamma（IFN-γ）were determined before and after surgery in the 2 groups. The prognosis was evaluated. Results On the 1st and 7th days after surgery,the levels of IL-6 and IL-10 in radiation-free group were higher than those before surgery （P<0.05）,and were higher than those in corresponding radiation group （P<0.05）. On the 1st and 7th days after surgery,the level of IFN-γ in radiation-free group was lower than that before surgery （P<0.01）,and was lower than that in corresponding radiation group （P<0.01）. On the 1st day after surgery,the level of TNF-α in radiation-free group was lower than that before surgery （P<0.05）,and was lower than that in corresponding radiation group （P<0.05）. On the 1st and 7th days after surgery,the levels of indices mentioned above in radiation group had no statistical significance compared with those before surgery （P>0.05）. The days staying in hospital and in intensive care unit （ICU）had no statistical significance between the 2 groups （P>0.05）. For 1,3 and 5 years after surgery,the survival rates in radiation group were higher than those in radiation-free group （P<0.05）. Conclusions Compared with common blood transfusion,perioperative blood transfusion with radiation in patients with esophageal carcinoma has no immune suppression,and has a good prognosis. Giving the complexity for the influence of blood transfusion on prognosis,large clinical trials are still needed to confirm the conclusions based on the control of other factors.

Key words: Red blood cell transfusion with radiation, Inflammatory factors, Prognosis, Esophageal carcinoma

中图分类号:

R446.62

刘业, 周晔, 陈波, 唐晓峰. 辐照红细胞输注对围术期食管癌患者血清炎性因子水平及预后的影响[J]. 检验医学, 2017, 32(4): 295-298.

LIU Ye, ZHOU Ye, CHEN Bo, TANG Xiaofeng. Influence of red blood cell transfusion with radiation on serum inflammatory factors and prognosis of perioperative patients with esophageal carcinoma[J]. Laboratory Medicine, 2017, 32(4): 295-298.

图/表 2

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组别	例数	时间	IL-6	IL-10	TNF-α	IFN-γ
未辐照组	78	术前	35.93 ± 3.74	22.61 ± 2.73	24.33 ± 2.08	25.54 ± 2.41
		术后1 d	51.06 ± 2.85^**	29.45 ± 2.45^*	20.12 ± 2.15^*	12.28 ± 1.97^**
		术后7 d	73.62 ± 2.90^**	30.17 ± 2.11^*	24.11 ± 2.67	15.89 ± 1.99^**
辐照组	81	术前	36.21 ± 3.40	23.25 ± 2.49	25.95 ± 2.61	26.71 ± 2.70
		术后1 d	38.33 ± 4.16^##	24.21 ± 2.02^#	25.83 ± 2.57^#	29.31 ± 3.02^##
		术后7 d	36.58 ± 4.02^##	23.46 ± 1.83^#	24.77 ± 3.06	28.14 ± 2.91^##

组别	例数	时间	IL-6	IL-10	TNF-α	IFN-γ
未辐照组	78	术前	35.93 ± 3.74	22.61 ± 2.73	24.33 ± 2.08	25.54 ± 2.41
		术后1 d	51.06 ± 2.85^**	29.45 ± 2.45^*	20.12 ± 2.15^*	12.28 ± 1.97^**
		术后7 d	73.62 ± 2.90^**	30.17 ± 2.11^*	24.11 ± 2.67	15.89 ± 1.99^**
辐照组	81	术前	36.21 ± 3.40	23.25 ± 2.49	25.95 ± 2.61	26.71 ± 2.70
		术后1 d	38.33 ± 4.16^##	24.21 ± 2.02^#	25.83 ± 2.57^#	29.31 ± 3.02^##
		术后7 d	36.58 ± 4.02^##	23.46 ± 1.83^#	24.77 ± 3.06	28.14 ± 2.91^##

组别	例数	住院时间（d）	住ICU时间（d）	生存率（%）
组别	例数	住院时间（d）	住ICU时间（d）	1年	3年	5年
未辐照组	78	22.55 ± 4.72	1.52 ± 0.98	64.95	34.62	27.21
辐照组	81	19.83 ± 3.90	1.18 ± 0.69	78.29	49.16	41.72
统计值		0.204	-0.491	4.147	4.023	4.978
P值		0.849	0.649	0.042	0.045	0.026

组别	例数	住院时间（d）	住ICU时间（d）	生存率（%）
组别	例数	住院时间（d）	住ICU时间（d）	1年	3年	5年
未辐照组	78	22.55 ± 4.72	1.52 ± 0.98	64.95	34.62	27.21
辐照组	81	19.83 ± 3.90	1.18 ± 0.69	78.29	49.16	41.72
统计值		0.204	-0.491	4.147	4.023	4.978
P值		0.849	0.649	0.042	0.045	0.026