CAJ | 학술논문

目的观察术中高渗氯化钠羟乙摹淀粉40注射液(HSS40)对恶性肿瘤患者体内自然杀伤细胞(NK细胞)和血小板活化分子CD41影响.方法将76例手术患者随机分两组:输血组(A组)38例、HSS40组(B组)38例.于麻醉前1 h、术后1、3、7 d抽取外周血,细胞检测仪检测CD56和CD41含量;以乳酸脱氢酶释放法检测NK细胞活性.结果组间比较:CD56术后第3、7天B组高于A组,差异显著(25.560±11.026比15.648±6.729;29.040±10.221比15.035±6.758,P<0.01),NK细胞活性术后第7天两组比较差异有统计学意义(19.939±6.994比15.307±5.107,P<0.05);CD4,术后l d B组明显低于A组(7.740 4-4.101比10.752 4-5.493,P<0.01).组内比较:A组术后第3天NK细胞活性下降(P<0.05),术后第7天下降明显,与术前比较差异有统计学意义(P<0.01),B组术后第7天NK细胞活性与术前比较差异有统计学意义(P<0.05),CD56术后第3天有所上升(P<0.05),术后第7天上升明显,与术前比较差异有统计学意义(P<0.01).两组CD41术后1～7 d均明显高于术前水平(P<0.01).结论手术和输血可导致术后NK细胞活性降低,血小板CD41含量明显升高,术中输注HSS40,术后NK细胞活性及数目不同程度升高,且降低血小板CD41含量.
목적 관찰술중고삼록화납간을모정분40주사액(HSS40)대악성종류환자체내자연살상세포(NK세포)화혈소판활화분자CD41영향.방법 장76례수술환자수궤분량조:수혈조(A조)38례、HSS40조(B조)38례.우마취전1 h、술후1、3、7 d추취외주혈,세포검측의검측CD56화CD41함량;이유산탈경매석방법검측NK세포활성.결과 조간비교:CD56술후제3、7천B조고우A조,차이현저(25.560±11.026비15.648±6.729;29.040±10.221비15.035±6.758,P<0.01),NK세포활성술후제7천량조비교차이유통계학의의(19.939±6.994비15.307±5.107,P<0.05);CD4,술후l d B조명현저우A조(7.740 4-4.101비10.752 4-5.493,P<0.01).조내비교:A조술후제3천NK세포활성하강(P<0.05),술후제7천하강명현,여술전비교차이유통계학의의(P<0.01),B조술후제7천NK세포활성여술전비교차이유통계학의의(P<0.05),CD56술후제3천유소상승(P<0.05),술후제7천상승명현,여술전비교차이유통계학의의(P<0.01).량조CD41술후1～7 d균명현고우술전수평(P<0.01).결론 수술화수혈가도치술후NK세포활성강저,혈소판CD41함량명현승고,술중수주HSS40,술후NK세포활성급수목불동정도승고,차강저혈소판CD41함량.
Objective To study the effect of small dose of hypertonic sodium chloride hydroxyethyl starch 40 infusion during cancer surgery on NK cells and CD41 content. Methods Seventy-six patients who underwent malignant tumor resection were randomly divided into two groups. In group A, 38 patients were treated with packed red cells, and in group B, 38 patients received hypertonic sodium chloride hydroxyethyl starch 40 infusion during surgery. The blood samples were collected 1 h before anesthesia and on the first, 3rd, 7th day after operation. The contents of CD56 and CD41 were measured by flow eytometry (FCM) , and the method of LDH release was used to determine the cytotoxicity of NK cells. Results The content of CD56 in group A was higher than that in group B (P <0.01) , and that of CD41 at the first day after operation was obviously decreased in group A as compared with group B (P < 0.01). There was significant difference in the NK cytotoxicity between these two groups on the 7th day after operation. The NK cytotoxicity was markedly decreased on the 3rd and 7th day after operation as compared with that before anesthesia (P < 0. 05, P < 0.01). In group B, the NK cytotoxicity was lower only on the 7th day after operation (P < 0. 05), but the content of CD56 was increased on the 3rd and 7th day after operation (P < 0.05, P < 0.01);The postoperative CD41 content was kept at a higher level than baseline during whole procedures in both two groups ( P < 0. 01). Conclusion Blood transfusion during surgery in cancer patients leads to the decrease of NK cyotoxicity after operation, while small dose of hypertonic sodium chloride hydroxyethyl starch 40 infusion can increase the amount of NK cells and the cyotoxicity of NK cells, and may be helpful in reducing CD41 content in peripheral platelets.