Effect of massive blood transfusion on T lymphocyte subsets, coagulation function and inflammatory factors in emergency trauma patients
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摘要: 目的 研究大量输血对急诊外伤患者T淋巴细胞亚群、凝血功能和炎症因子水平的影响。方法 选择2018年5月—2021年1月收治的需输血的急性创伤患者92例，根据患者输血量分为A组(48例)和B组(44例)，其中A组为需要大量输血治疗，B组为非大量输血治疗。比较2组患者治疗前后T淋巴细胞亚群、凝血功能和炎症因子水平变化，并观察血液指标情况。结果 A组患者红细胞、血浆、血小板以及冷沉淀的输注量均显著高于B组(P< 0.05)；2组患者治疗前、治疗后5 d T淋巴细胞亚群、凝血功能和炎症因子水平比较差异无统计学意义(P>0.05)，治疗后1 d，2组白介素-6、血红蛋白水平比较差异无统计学意义(P>0.05)，但A组患者T淋巴细胞亚群水平、纤维蛋白原水平、血小板计数水平显著低于B组，凝血酶原时间、凝血酶时间、活化部分TT、肿瘤坏死因子-α、C反应蛋白水平显著高于B组，差异有统计学意义(P< 0.05)。结论 大量输血虽可促进急诊创伤患者血容量的恢复，但输血可能会对机体凝血功能、免疫功能产生影响，并可能加重机体炎症反应。Abstract: Objective To study the effect of massive blood transfusion on T lymphocyte subsets, coagulation function and inflammatory factors in emergency trauma patients.Methods Ninety-two emergency trauma patients who required blood transfusion in the hospital were selected as the research subjects between May 2018 and January 2021. According to blood transfusion volume, the patients were divided into group A(48 cases, massive blood transfusion) and group B(44 cases, non-massive blood transfusion). The changes in T lymphocyte subsets, coagulation function and inflammatory factors were compared between the two groups, and blood indexes were observed.Results The infusion volume of erythrocytes, plasma, platelets, and cryoprecipitate in group A was significantly greater than those in group B(P< 0.05). There were no statistically significant differences in T lymphocyte subsets, coagulation function, and inflammatory factor levels between the two groups before and at 5 d after treatment(P>0.05). 1 day after treatment, there were no significant differences in the levels of interleukin-6 and hemoglobin between the two groups(P>0.05), but the levels of T lymphocyte subsets, fibrinogen and platelet count in group A were significantly lower than those in group B, prothrombin time, thrombin time, activated partial TT, levels of tumor necrosis factor-α and C-reactive protein were significantly longer or higher than those in group B(P< 0.05).Conclusion Although massive blood transfusion can promote the recovery of blood volume in emergency trauma patients, coagulation function and immune function may be affected during transfusion, which may aggravate inflammatory response.
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表 1 2组患者输血成分比较
U，X±S 分组 红细胞 血浆 血小板 冷沉淀 A组 4356.28±125.84 3856.27±134.56 3018.93±150.46 2046.79±124.76 B组 4061.87±113.94 3429.61±116.35 2552.79±143.79 1789.43±113.95 t 18.895 16.200 15.161 10.300 P < 0.001 < 0.001 < 0.001 < 0.001 
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表 2 2组患者T淋巴细胞亚群水平比较
X±S 指标 A组 B组 t P CD3+ 治疗前 61.28±5.63 62.08±3.41 0.815 0.417 治疗后1 d 54.32±4.681) 56.83±4.161) 2.709 0.008 治疗后5 d 60.82±4.912) 61.73±3.542) 1.012 0.314 CD4+ 治疗前 32.19±3.57 31.46±4.15 0.907 0.367 治疗后1 d 24.76±3.121) 26.37±2.861) 2.573 0.012 治疗后5 d 30.86±2.982) 31.57±3.452) 1.058 0.293 CD8+ 治疗前 25.24±3.25 24.32±1.63 1.692 0.094 治疗后1 d 21.61±2.751) 23.37±3.051) 2.911 0.005 治疗后5 d 24.87±2.442) 25.08±2.532) 0.405 0.686 与治疗前比较，1)P < 0.05；与治疗后1 d比较，2)P < 0.05。
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表 3 2组患者凝血功能比较
X±S 指标 A组 B组 t P PT/s 治疗前 13.51±2.64 14.18±2.78 1.186 0.239 治疗后1 d 17.43±3.521) 15.87±3.12 2.241 0.028 治疗后5 d 13.95±2.61 13.03±2.12 1.846 0.068 TT/s 治疗前 15.37±3.45 15.92±2.96 0.817 0.416 治疗后1 d 20.41±4.751) 18.09±3.34 2.687 0.009 治疗后5 d 16.73±3.64 15.83±3.15 1.263 0.210 APTT/s 治疗前 35.18±6.73 34.81±5.57 0.286 0.776 治疗后1 d 40.86±7.061) 36.27±5.48 3.461 0.001 治疗后5 d 35.62±6.24 34.96±4.82 0.564 0.574 FIB/(g·L-1) 治疗前 3.82±1.19 3.76±1.22 0.239 0.812 治疗后1 d 2.76±1.261) 3.26±1.08 2.035 0.045 治疗后5 d 3.22±1.36 3.69±1.17 1.769 0.080 与治疗前比较，1)P < 0.05。
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表 4 2组患者炎症因子水平比较
X±S 指标 A组 B组 t P TNF-α/(pg·mL-1) 治疗前 15.42±1.61 16.15±2.36 1.746 0.084 治疗后1 d 19.63±3.251) 18.17±3.431) 2.096 0.039 治疗后5 d 16.47±2.242) 15.93±2.192) 1.167 0.246 CRP/(ng·mL-1) 治疗前 8.04±0.89 8.27±1.14 1.083 0.286 治疗后1 d 13.34±2.451) 11.67±2.231) 3.409 0.001 治疗后5 d 9.13±1.242) 8.74±1.312) 1.467 0.146 IL-6/(ng·mL-1) 治疗前 18.56±1.74 19.01±2.63 0.975 0.332 治疗后1 d 23.21±5.251) 21.82±5.381) 1.254 0.213 治疗后5 d 19.16±2.442) 18.84±2.282) 0.648 0.518 与治疗前比较，1)P < 0.05；与治疗后1 d比较，2)P < 0.05。
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表 5 2组患者血液指标水平比较
X±S 指标 A组 B组 t P PLT/(×109·L-1) 治疗前 122.67±28.16 125.37±30.53 0.441 0.660 治疗后1 d 86.25±32.481) 100.47±31.291) 2.135 0.036 治疗后5 d 113.09±27.38 120.39±33.24 1.154 0.252 Hb/(g·L-1) 治疗前 81.74±17.35 81.04±16.33 0.199 0.843 治疗后1 d 86.35±15.32 84.19±14.11 0.701 0.485 治疗后5 d 84.29±13.64 83.05±14.67 0.420 0.675 与治疗前比较，1)P < 0.05。
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