Effect Of Intraoperative Blood Transfusion On Treg And FOXP3 In Blood Of Patients With Digestive Tract Malignant Tumors Among Different ABO Blood Types

Objective: In this study,patients with digestive tract malignant tumors who underwent elective radical resection were selected as subjects,changes and trends in the amount of CD4⁺CD25⁺CD127^low Treg?Regulatory T cell?and the expression of FOXP3?Forkhead Box Protein 3?in their blood after transfusion were detected.Investigate the effect of intraoperative blood transfusion on Treg and FOXP3 in blood of patients with digestive tract malignant tumors among different ABO blood types,and provide a certain reference for the individualized blood management of patients with different ABO blood types.Methods:?1?This study selected 80 patients who were diagnosed as digestive tract malignant tumor by gastroscopy and needed radical resection from July 2018 to May 2019.The ASA?American Society of Anesthesiologists?physical status was classified as ? or ?;Preoperative Hb?Hemoglobin?< 100g/L;Age between 40 and 65 years;BMI?Body Mass Index?18.5-24.9kg/m²;Rh blood type was positive;Patients with severe lung or heart disease,immune dysfunction,abnormal white blood cell count or platelet count,abnormal coagulation,with a history of blood transfusion before surgery,no blood transfusion or massive transfusions during surgery,and postoperative blood transfusion after surgery were excluded.?2?The patients were divided into four groups according to different blood types,with 20 patients in each group,respectively A blood group,B blood group,O blood group and AB blood group.?3?All patients were treated with combined epidural and general anesthesia.Monitor the arterial blood gas during the operation and decide whether or not to transfusion and transfusion volume according to Hb.Transfusion of red blood cells is indicated when Hb< 70g/L but is not indicated when Hb > 100g/L,and depends on the condition when Hb between 70 100g/L.?4?All patients collected peripheral venous blood before surgery,immediately after transfusion,1 day after transfusion,and 5 days after transfusion.Flow cytometry was used to detect and compare the amount of CD4⁺CD25⁺CD127^low Treg in the blood of patients with different blood types,and RT-PCR?real time reverse transcription polymerase chain reaction?was used to detect and compare the expression of FOXP3 m RNA in the blood of patients with different blood types.?5?Between-group and within-group ANOVA was performed on CD4⁺CD25⁺CD127^low Treg and FOXP3 m RNA in four groups of patients with different blood types to compare the changes and trends in amount of CD4+CD25+CD127low Treg and the expression of FOXP3 m RNA before surgery,immediately after transfusion,1 day after transfusion and 5 days after transfusion.The comparison within groups at different time points was performed by repeated measures ANOVA,and the comparison between different groups at same time point was performed by Bonferroni test.Discrete data were compared using chi-square test or Fisher's exact test.P <0.05 was considered as statistically significant.Results:?1?There were no significant differences in age,gender,BMI,tumor type,treatment history,preoperative hemoglobin,operation time,operative technique,and intraoperative blood transfusion volume among the four groups of patients.?2?There was no significant difference in the amount of CD4⁺CD25⁺CD127^low Treg and the expression of FOXP3 m RNA in blood among four groups of patients before surgery.?3?The amount of CD4⁺CD25⁺CD127^low Treg and the expression of FOXP3 m RNA began to increase in four groups of patients after blood transfusion.Among them,it increased immediately after blood transfusion,but there was no significant difference compared with that before surgery;it was significantly increased on 1 day after transfusion and the difference was statistically significant compared with that before surgery;it basically returned to pre-operative level on 5 days after transfusion and there was no significant difference compared with that before surgery.?4?The degree of increase in the amount of CD4⁺CD25⁺CD127^low Treg and the expression of FOXP3 m RNA was different after transfusion in patients with different blood types,with the highest in B blood group and the lowest in A blood group,the difference was statistically significant.Conclusion: Intraoperative blood transfusion can increase the levels of Treg and FOXP3 in the blood of patients with digestive tract malignant tumors,especially at 1 day after surgery and basically recover at 5 days after surgery.And the degree of increase in Treg and FOXP3 in blood of patients with digestive tract malignant tumors among different blood types is different after intraoperative blood transfusion,among which blood type B is the highest and blood type A is the lowest.