The Impact Of Acute Non-normovolemic Hemodilution On Perioperative NK Cell、NKT Cell And Th1/Th2 In Patients Undergoing Rectal Carcinoma Radical Resection

Objective:This study is aimed at researching the impact of acute non-normovolemic hemodilution(ANIH) on the numbers of NK cell、the NK cytotoxicity、numbers of NKT cell and the ratio of Th1/Th2 cytokines in patients undergoing rectal carcinoma radical resection. Thereby provide identifiable ground for the protection and improvement of rectal cancer patients’ cellular immune function during perioperative period.Methods:The study was carried out in 40 patients, aged between 50 and 75, body weight 45 to 75kg, ASA physical status I or II, Dukes classification B or C, undergoing Rectal Carcinoma Radical Resection(Mile’s). The patients haven’t serious cardiac-cerebral vascular disease and endocrine disease,neither have immune system disease, didn’t receive radiotherapy or chemotherapy or hormonotherapy yet. The preoperative hematocrit(Hct) need greater than 35%, and the estimated amount of bleeding intraoperative need less than 800ml.40 cases in accordance with the random number table, were divided into two groups (n=20):Conventional Infusion(Group Ⅰ) and acute non-normovolemic hemodilution(Group II). The patients in two group receive the same anesthesia and postoperative analgesia. All of them were infused Compound electrolyte solution at the rate of 5-7ml/(kg·h) to supplement the physiological requirement and Third-space fluid loss intraoperative. Group I:didn’t transfuse allogeneic blood, before the end of surgery infuse Succinylated gelatin injection(4%) the same amount as intraoperative blood loss. Group II:collecting autologous blood 400-600ml (approximately 10%-15% of blood circulatory volume in patient’s circulation) from radial artery with ACD blood bag before anesthesia induction. Then infusing Succinylated gelatin injection (4%) 1000-1200ml at the rate of 50ml/min, while continuous monitoring patients’s SpHb and PVI with Masimo Radical-7 Carbon and Oxygen Pulse Oximetry to observe the change of hemoglobin and blood volume around hemodilution. Then reinfusion autologous before the end of surgery or when the SpHb<80g/l. Patient with allogeneic blood transfusion intraoperative will be excluded from the study. We take the venous blood samples at 4 time points including 1 day before surgery (T1), the first day after surgery (T2), the third day after surgery (T3), the seventh day after surgery (T4) and measure NK cell、 NK cytotoxicity、NKT cell、Th1 cytokines (IL-2、IFN-γ) and Th2 cytokines(IL-4、 IL-10) by flow cytometry. Then calculate the rate of Thl/Th2 [Thl/Th2=(IL-2+IFN-γ)÷(IL-4+IL-10)] to observe its variation trend. We can observe the change of rectal cancer patients’ cellular immune function according to these dates.Results:There were no significant difference in patients’ age、height% weight、sex ratio、 operation time、ASA classification and Ducks classification (p<0.05). But infusion volume in acute non-normovolemic hemodilution (Group II) is more than Conventional Infusion (Group I) (p<0.05). The change of NK cell numbers: Compared with T1,both group I and group II increaseat T2, but it hasn’t statistical difference (P>0.05). At T3 group II increase greatly, compared with group Ⅰ, which has a noticeable statistical variation (p<0.05). Both group have markedly reduce at T4 (p<0.05), and the group I is lower than group II. The difference between two group has statistical difference (p<0.05). The change of NK cytotoxicity:Compared with T1, both group decrease at T2, and the change of group I is more obviously (p<0.01). The difference between group I and II has significant statistical difference (p<0.05). At T3 both group increase and compared with T1、T2 it has statistical difference (p<0.05). The group II is more than group I (p<0.05). At T4 both group decrease to the preoperative level. No statistical difference between two group (p>0.05). The change of NKT cell:Compared with T2, both group increase at T3 (p<0.05), and the augment of group II is more than group I (p<0.05). At T4 group II has obvious decrease compared with T3 (p<0.01). But there is no statistical difference between two group (p>0.05) at T4. The change of Th1/Th2:Compared with T1, group II reduce at T2 (p<0.01), and it rise gradually at T3 and T4(p<0.05). But there is no statistical difference between two group at any time point ((p>0.05).Conclusions:Compared withconventional infusion,acute non-normovolemic hemodilution could protect the perioperation cellular immunity in patients with rectal carcinomand benefit the anti-tumor immunity through increasing the numbers of NK cell and NKT cell and enforcing NK cytotoxicity. However, it appears no influence on the balance of Thl/Th2. We could use acute non-normovolemic hemodilution as an effective measure of blood protection to improve the perioperation cellular immunity in rectal carcinoma patients.