腰椎后路手术血液回收过程中中性粒细胞胞外诱捕网的产生与洗涤效果评价
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摘要
目的探讨腰椎后路手术术中血液回收(IBS)过程中是否存在中性粒细胞胞外诱捕网(NETs)及NETs相关成分DNA、组蛋白和核小体的生成,以及自体血清洗程序是否可以清除NETs成分。方法回顾性选取2017年1～6月于首都医科大学附属北京友谊医院行腰椎后路手术患者20例,术中使用自体血液回收。抽取术前外周静脉血(0期)、自体血回收罐中血(1期)和洗涤后回输前的自体血(2期)的血液样本。检测样本中NETs相关成分DNA、核小体、髓过氧化物酶(MPO)含量。结果与术前外周静脉血(DNA:21. 92±24. 87 ng/ml,核小体0. 03±0. 02,MPO 5. 41±2. 48 ng/ml)相比,自体血回收罐中血液NETs及其相关成分含量明显增高(DNA:3 256. 56±1 952. 04 ng/ml,核小体:3. 06±0. 34,MPO 493. 23±232. 33 ng/ml),经过洗涤后,回收血液的上述成分明显降低(DNA:146. 62±123. 82,核小体:1. 59±0. 48,MPO:64. 73±38. 49 ng/ml),但仍高于术前水平,差异均有显著性(P <0. 05)。结论腰椎后路手术血液回收过程中存在中性粒细胞激活产生NETs,血液洗涤可以使NETs水平降低,但仍高于术前水平。
Objective To investigate the presence of NETs production and related products DNA,histone and myeloperoxidase( MPO)during blood recovery( IBS) in lumbar posterior surgery,and whether the autologous serum washing procedure can remove NETs components.Methods 20 patients undergoing posterior lumbar surgery in Beijing Friendship Hospital from January to June 2017 were selected and autologous blood was collected during the operation. Blood samples of peripheral venous blood( phase 0),autologous blood collection tank( phase 1) and autologous blood( phase 2) before transfusion after washing were collected. The contents of NETs related components including DNA,nucleosome and myeloperoxidase( MPO) in the samples were detected. Results Compared with the preoperative peripheral venous blood( DNA: 21. 92 ±24. 87 ng/ml,Nucleosome: 0. 03 ± 0. 02,MPO 5. 41 ± 2. 48 ng/ml),the blood NETs and related components in the autologous blood recovery tank increased significantly( DNA: 3 256. 56 ± 1 952. 04 ng/ml,Nucleosome: 3. 06 ± 0. 34,MPO 493. 23 ± 232. 33 ng/ml). After washing,the above components in the recycled blood decreased significantly( DNA: 146. 62 ± 123. 82,Nucleosome: 1. 59 ± 0. 48,MPO: 64. 73 ± 38. 49 ng/ml),but still higher than the preoperative level. The results were significantly different( P < 0. 05). Conclusion Neutrophil activation produces NETs in the blood recovery process of lumbar posterior surgery. Blood washing can reduce the level of NETs,but it is still higher than the preoperative level.
Objective To investigate the presence of NETs production and related products DNA,histone and myeloperoxidase( MPO)during blood recovery( IBS) in lumbar posterior surgery,and whether the autologous serum washing procedure can remove NETs components.Methods 20 patients undergoing posterior lumbar surgery in Beijing Friendship Hospital from January to June 2017 were selected and autologous blood was collected during the operation. Blood samples of peripheral venous blood( phase 0),autologous blood collection tank( phase 1) and autologous blood( phase 2) before transfusion after washing were collected. The contents of NETs related components including DNA,nucleosome and myeloperoxidase( MPO) in the samples were detected. Results Compared with the preoperative peripheral venous blood( DNA: 21. 92 ±24. 87 ng/ml,Nucleosome: 0. 03 ± 0. 02,MPO 5. 41 ± 2. 48 ng/ml),the blood NETs and related components in the autologous blood recovery tank increased significantly( DNA: 3 256. 56 ± 1 952. 04 ng/ml,Nucleosome: 3. 06 ± 0. 34,MPO 493. 23 ± 232. 33 ng/ml). After washing,the above components in the recycled blood decreased significantly( DNA: 146. 62 ± 123. 82,Nucleosome: 1. 59 ± 0. 48,MPO: 64. 73 ± 38. 49 ng/ml),but still higher than the preoperative level. The results were significantly different( P < 0. 05). Conclusion Neutrophil activation produces NETs in the blood recovery process of lumbar posterior surgery. Blood washing can reduce the level of NETs,but it is still higher than the preoperative level.
引文
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[2] Han S,Kim G,Ko JS,et al. Safety of the Use of Blood Salvage and Autotransfusion During Liver Transplantation for Hepatocellular Carcinoma[J]. Ann Surg,2016,264(2):339-343.
[3] Paparella D,Whitlock R. Safety of Salvaged Blood and Risk of Coagulopathy in Cardiac Surgery[J]. Semin Thromb Hemost,2016,42(2):166-171.
[4] Yipp BG,Kubes P. NETosis:how vital is it[J]? Blood,2013,122(16):2784-2794.
[5] Jorch SK,Kubes P. An emerging role for neutrophil extracellular traps in noninfectious disease[J]. Nat Med,2017,23(3):279-287.
[6] Stiff PJ,Micallef I,Nademanee AP,et al. Transplanted CD34(+)cell dose is associated with long-term platelet count recovery following autologous peripheral blood stem cell transplant in patients with nonHodgkin lymphoma or multiple myeloma[J]. Biol Blood Marrow Transplant,2011,17(8):1146-1153.
[7] Yang H,Biermann MH,Brauner JM,et al. New Insights into Neutrophil Extracellular Traps:Mechanisms of Formation and Role in Inflammation[J]. Front Immunol,2016,7:302.
[8] Brinkmann V. Neutrophil Extracellular Traps in the Second Decade[J]. J Innate Immun,2018,10(5-6):414-421.
[9] Choi ES,Ahn WS,Lee JM,et al. A laboratory study of the effects of processing blood through a cell salvage device and leucocyte depletion filter on levels of pro-inflammatory cytokines and bradykinin[J]. Anaesthesia,2013,68(12):1259-1265.
[10] Burman JF,Westlake AS,Davidson SJ,et al. Study of five cell salvage machines in coronary artery surgery[J]. Transfus Med,2002,12(3):173-179.
[11] Lindholm E,Seljeflot I,Aune E,et al. Proinflammatory cytokines and complement activation in salvaged blood from abdominal aortic aneurism surgery and total hip replacement surgery[J]. Transfusion,2012,52(8):1761-1769.
[12] Yang S,Qi H,Kan K,et al. Neutrophil Extracellular Traps Promote Hypercoagulability in Patients With Sepsis[J]. Shock,2017,47(2):132-139.
[13] Ward PA,Grailer JJ. Acute lung injury and the role of histones[J].Transl Respir Med,2014,2:1.
[14] Mc Donald B,Davis RP,Kim SJ,et al. Platelets and neutrophil extracellular traps collaborate to promote intravascular coagulation during sepsis in mice[J]. Blood,2017,129(10):1357-1367.
[15] Thomas GM,Carbo C,Curtis BR,et al. Extracellular DNA traps are associated with the pathogenesis of TRALI in humans and mice[J].Blood,2012,119(26):6335-6343.