摘要
目的:对比研究术中输注羟乙基淀粉注射液(HES)、聚明胶肽注射液(PG)和复方氯化钠注射液(LR)对食道癌患者术后T淋巴细胞及其亚群和细胞因子IL-2、IL-6、TNF-a的影响。
方法:51例ASAⅠ-Ⅱ级拟行食道癌手术患者,随机分为羟乙基淀粉注射液组(H组)、聚明胶肽注射液组(P组)和复方氯化钠注射液组(L组)三组,每组17例,每组分别按33ml/kg于术中输注HES、PG和LR。每例患者分别于麻醉前(d0),术后第一天(d1)、第三天(d3)、第七天(d7)取外周静脉血,用流式细胞技术测定T淋巴细胞及其亚群的数量,用ELISA法测定血清中IL-2、IL-6、TNF-a的含量。
结果:三组患者术前各指标差异无统计学意义(P>0.05)。与术前相比,三组患者CD3、CD4含量在术后第一天明显下降(P﹤0.01),术后第三天有所回升,但仍明显低于术前水平(P﹤0.05)。术后第一天P组CD4含量较L组明显下降(P﹤0.05);术后第三天H组和P组CD3、CD4含量均高于L组(P﹤0.05);术后第七天三组患者CD3、CD4含量均恢复至术前水平。CD8、CD4/CD8值三组患者间无差异(P>0.05)。IL-2含量在H组术后高于L组(P﹤0.05)。TNF-α含量在H组术后d1、d3、d7呈下降趋势,P组术后d1、d3呈上升趋势,术后d7下降至术前水平;TNF-α含量H组、P组与L组比较均有统计学差异(P﹤0.05)。IL-6含量三组患者术后d1均出现上升趋势、以P组最为明显,与术前比较差异均有统计学意义(P﹤0.05);IL-6含量在三组患者术后三天开始回落,术后七天基本恢复至术前水平;IL-6含量在P组明显高于L组(P﹤0.05)。
结论:术中输注羟乙基淀粉注射液(33ml/kg)对食道癌患者术后免疫功能有一定的改善作用,不刺激机体产生炎症反应。聚明胶肽注射液(33ml/kg)对食道癌患者术后免疫功能产生一过性抑制,但很快恢复,同时亦可使机体炎性细胞因子增多。此类肿瘤患者术中胶体液选择,以羟乙基淀粉为优。
Objective:To observe the effects of different colloids ( Hydroxyethyl Starch Injection, HES; Polygeline Injection, PG) and Ringer's solution on T lymphocytes and T cell subgroup, IL-6, IL-2 and TNF-a in patients after esophageal carcinoma surgery.
Methods:Fifty-one ASAⅠ-Ⅱpatients with esophageal carcinoma (male 37, female 14) were randomly assigned to three groups, 17 patients in each group. Hydroxyethyl Starch Injection (group H), Polygeline Injection (group P) and Ringer's solution (group L) were infused by 33ml/kg during surgery respectively in each group. The blood samples were collected before anesthesia (d0) and on the first day (d1), 3rd day (d3), 7th day (d7) after operation. Flow cytometry was used to measure the amounts of T lymphocyte and T cell subgroup. ELISA was used to determine the contents of IL-6, IL-2, TNF-a.
Results:No significant differences were found in all measurement indicators among the 3 groups on d0(P>0.05).The counts of CD3,CD4 descended markedly on d1(P﹤0.01) in all groups, and went up on d3, but were still lower than those on d0(P﹤0.01), and restored to normal on d7. The count of CD4 in group P was lower than that in group L on d1(P﹤0.05). The counts of CD3,CD4 in group H and group P were higher than those in group L on d3(P﹤0.05). The counts of CD8, CD4/CD8 were no significantly differences in each group(P>0.05). The count of IL-2 ascended in group H, and had statistical difference compared with group L on d1,d3 and d7 (P﹤0.05),but no significant difference was found between group P and group L. The count of TNF-αdescended in group H on d1,d3,d7 and ascended in group P on d1,d3,but restored to normal on d7. Group H, as well as group P, has statistical difference compared with group L (P﹤0.05). The count of IL-6 ascended in each group on d1, particularly in group P, and has statistical difference compared with that on d0 (P﹤0.05), and declined on d3 ,restored to normal on d7. Compared with group L , The count of IL-6 in Group P has statistical difference (P﹤0.05),but the group H has no statistical difference.
Conclusions:Hydroxyethyl starch injection (33ml/kg) infusion during surgery can improve the immune function of patents with esophageal carcinoma and doesn’t stimulate the inflammatory reaction after operation. Polygeline injection (33ml/kg) can produce a transient immunosuppression of patients with esophageal carcinoma on the early postoperative stage, but make it recover in time; meanwhile Polygeline injection can provoke inflammatory reaction. Hydroxyethyl starch injection infusion during surgery is better than polygeline injection in patients with esophageal carcinoma.
引文
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