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首页> 外文期刊>Journal of the American College of Cardiology >Impact of red blood cell transfusion on platelet aggregation and inflammatory response in anemic coronary and noncoronary patients: The TRANSFUSION-2 study (Impact of transfusion of red blood cell on platelet activation and aggregation studied with flow cytometry use and light transmission aggregometry)
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Impact of red blood cell transfusion on platelet aggregation and inflammatory response in anemic coronary and noncoronary patients: The TRANSFUSION-2 study (Impact of transfusion of red blood cell on platelet activation and aggregation studied with flow cytometry use and light transmission aggregometry)

机译：红细胞输血对贫血的冠状动脉和非冠状动脉患者血小板聚集和炎症反应的影响：TRANSFUSION-2研究（通过流式细胞术和光透射凝集法研究红细胞输注对血小板活化和聚集的影响）

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Objectives This study sought to determine whether red blood cell (RBC) transfusion increases in vivo platelet aggregation and inflammation in coronary and noncoronary patients. Background RBC transfusion increases in vitro platelet activation and aggregation in healthy volunteers, providing a possible explanation for the increase in recurrent ischemic events and mortality reported after RBC transfusion in patients with acute coronary syndromes (ACS). Methods Platelet reactivity was measured before and after RBC transfusion in 61 patients (33 with ACS patients and 28 without ACS). Relative changes between baseline and post-transfusion measurements of maximal and residual platelet aggregation were considered with different agonists as well as changes in vasodilator-stimulated phosphoprotein platelet reactivity index and P-selectin expression. Inflammatory and thrombotic biomarkers were also measured before and after transfusion. Results After RBC transfusion, platelet reactivity was increased when measured using adenosine diphosphate-induced light transmission aggregometry (11.6% relative increase in maximal platelet aggregation, p = 0.004; 10.8% increase in residual platelet aggregation, p = 0.005) and vasodilator-stimulated phosphoprotein platelet reactivity index (20.7% relative increase, p = 0.002), and there was a nonsignificant trend toward an increase in P-selectin expression. Similar results were found with the nonspecific agonist thrombin receptor-activated peptide (relative increases of 11.7% for maximal platelet aggregation, p = 0.04, and 12.7% for residual platelet aggregation, p = 0.02) but not with collagen or arachidonic acid agonists. There were no significant differences in inflammatory and thrombotic biomarkers before and after transfusion. Conclusions After RBC transfusion, there is an increase in platelet reactivity, especially with tests measuring the adenosine diphosphate-P2Y12 receptor pathway, without significant variations in inflammatory or thrombotic biomarkers. This in vivo effect may account for the excess of ischemic events observed in the context of patients with ACS treated using percutaneous coronary intervention and P2Y12 inhibitors.
机译：目的本研究旨在确定红细胞（RBC）输注是否会增加冠状动脉和非冠状动脉患者的体内血小板聚集和炎症。背景RBC输注增加了健康志愿者的体外血小板活化和聚集，为急性冠脉综合征（ACS）患者RBC输注后复发性缺血事件和死亡率增加提供了可能的解释。方法在61例患者中（33例ACS患者和28例不使用ACS的患者），在RBC输注前后测量血小板反应性。基线和输血后最大和残留血小板凝集之间的相对变化被认为是使用了不同的激动剂，以及血管扩张剂刺激的磷蛋白血小板反应性指数和P-选择蛋白表达的变化。在输血之前和之后还测量了炎症和血栓形成生物标志物。结果RBC输注后，使用二磷酸腺苷诱导的光凝集法测定血小板反应性（最大血小板聚集相对增加11.6％，p = 0.004;残余血小板聚集相对增加10.8％，p = 0.005）和血管扩张剂刺激的磷蛋白血小板反应性指数（相对增加20.7％，p = 0.002），并且P-选择素表达增加的趋势不明显。非特异性激动剂凝血酶受体激活肽也发现了相似的结果（最大血小板聚集相对增加11.7％，p = 0.04，残余血小板聚集相对增加12.7％，p = 0.02），而胶原蛋白或花生四烯酸激动剂则没有。输血前后炎症和血栓形成生物标志物无明显差异。结论RBC输注后，血小板反应性增加，特别是通过测量二磷酸腺苷-P2Y12受体途径的试验，而在炎症或血栓形成生物标志物上没有显着变化。这种体内作用可能解释了在使用经皮冠状动脉介入治疗和P2Y12抑制剂治疗的ACS患者中观察到的局部缺血事件过多。

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