丙泊酚对肝部分切除术治疗的原发性肝癌患者外周血淋巴细胞亚群和血清肿瘤相关标志物水平的影响

doi:10.3969/j.issn.1672-5069.2018.05.023

摘要/Abstract

摘要： 目的探讨丙泊酚对肝部分切除术治疗的原发性肝癌（PLC）患者外周血T淋巴细胞亚群和血清肿瘤相关标志物水平的影响。方法 2010年2月~2014年4月我院收治的PLC患者92例,采用随机数字表法将患者分为丙泊酚组和异氟醚组,每组46例。在行肝叶切除术时,分别采用相应的麻醉方法。使用流式细胞仪检测外周血CD3⁺、CD4⁺、CD8⁺细胞百分比和CD4⁺/CD8⁺细胞比值,采用酶联免疫吸附法检测血清E-钙蛋白（EC）、血管内皮生长因子（VEGF）和基质金属蛋白酶（MMP）水平,并观察两组不良反应和生存情况。结果在麻醉前,两组外周血CD3⁺、CD4⁺、CD8⁺细胞百分比和CD4⁺/CD8⁺细胞比值无显著性差异（P>0.05）,在术后1d,丙泊酚麻醉组血CD3⁺和CD4⁺细胞分别为（56.3±4.8） %和（36.8±5.7） %,显著高于异氟醚组的（52.5±4.5）%和（34.2±4.2）%（P<0.05）;在麻醉前,两组血清EC、VEGF和MMP水平无显著性差异（P>0.05）,在术后14d,丙泊酚麻醉组血清EC、VEGF和MMP水平分别为（1763.3±112.7） ng/ml、（201.9±36.9） pg/ml和（32.4±4.2）ng/L,显著低于异氟醚组的（2318.4±153.9） ng/ml、（369.9±56.8） pg/ml和（72.5±7.2） ng/L（P<0.05）;术后丙泊酚组白细胞下降发生率为47.8%,显著低于异氟醚组的69.6%（P<0.05）;随访3年,两组患者生存率无显著性差异（P>0.05）。结论丙泊酚可有效减轻PLC患者术后免疫抑制状态,减少并发症的发生,可能有助于患者术后的康复。

关键词: 原发性肝癌, 丙泊酚, 麻醉, 外周血淋巴细胞亚群, 血清肿瘤相关标志物

Abstract: Objective To investigate the effectsof propofol on peripheral blood lymphocyte subsets and serum tumor related markers in patients with primary liver cancer（PLC） receiving partial hepatectomy（PH）. Methods A total of 92 patients with PLC were recruited in our hospital between February 2010 and April 2014,and were divided into propofol and isoflurane group,with 46 in each when PH was done. The percentages of peripheral blood lymphocyte subsets were detected by FCM,and serum E-cadherin（EC）,vascular endothelial growth factor（VEGF） and matrix metalloproteinase（MMP） levels were detected by ELISA. Results The percentages of peripheral blood CD3⁺,CD4⁺ and CD8⁺ cells,and the ratio of CD4⁺/CD8⁺ showed no significant differences between the two groups before anesthesia（P>0.05）,while 1 day after operation,the percentage of CD3⁺ and CD4⁺ cells were （56.3±4.8）% and （36.8±5.7）% in the propofol group,significantly higher than （52.5±4.5）% and （34.2±4.2）% in the isoflurane group （P<0.05）;before anesthesia,there was no significant difference as recpect to serum EC,VEGF and MMP levels between the two group（P>0.05）,while 14 days after operation,serum levels of these three cytokines were （1763±112.7） ng/ml,（201.9±36.9） pg/ml and（32.4±4.2） ng/L in the propofol group,significantly lower than （2318±153.9） ng/ml,（369.9±56.8） pg/mL and（72.5±7.2） ng/L in the isoflurane group （P<0.05）;the incidence rate of leukopenia in the propofol group was significantly lower than that in the isoflurane group（47.8% vs. 69.6%,P<0.05）;there were no significant differences between the two groups as respect to the postoperative 3-year survival rates（P>0.05）. Conclusion Propofol can effectively relieve the postoperative immunosuppression in patients with PLC,which might inhibit tumor cell metastasis and improve the recovery.

Key words: Hepatoma, Aneasthesia, Propofol, Peripheral blood lymphocyte subsets, Serum tumor related markers

伍家彬, 谢晓海. 丙泊酚对肝部分切除术治疗的原发性肝癌患者外周血淋巴细胞亚群和血清肿瘤相关标志物水平的影响[J]. 实用肝脏病杂志, 2018, 21(5): 745-748.

Wu Jiabing, Xie Xiaohai.. Effects of propofol on peripheral blood lymphocyte subsets and serum tumor related markers in patients with primary liver cancer receiving partial hepatectomy[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(5): 745-748.

参考文献

[1] 孙鹏,吴力群,王祖森,等. 原发性肝癌肝切除术后并发症严重程度影响因素分析(附84例报告). 中国实用外科杂志,2015,35(5):528-530.
[2] Cong WM,Wu MC.New insights into molecular diagnostic pathology of primary liver cancer:Advances and challenges. Cancer Lett,2015,368(1):14-19.
[3] 叶明. 原发性肝癌患者血清IL-6、IL-18和IL-18BP检测的意义. 实用肝脏病杂志,2016,19(3):354-355.
[4] Nozaki K,Endou A,Sakurai K,et al.Anesthetic management of a patient with a giant bulla and liver cirrhosis using a laryngeal mask airway and epidural analgesia. Masui,2001,50(6):639-641.
[5] Azma T,Kawai K,Okida M,et al.Use of the laryngeal mask airway in combination with regional anesthesia facilitates induction and emergence from general anesthesia in patients undergoing colorectal surgery. Hiroshima J Med Sci,2002,51(4):89-92.
[6] Iwama H,Obara S,Ozawa S,et al. A survey of combined epidural-propofol anesthesia with noninvasive positive pressure ventilation as a minimally invasive anesthetic protocol. Med Sci Monit,2003,9(7):CR316-323.
[7] Bai J,Lin C,Huijin YE,et al.Propofol suppresses migration and invasion of breast cancer MDA-MB-231 cells by down-regulating H19. J Southern Med Univ,2016,36(9):1255-1259.
[8] Noor M,Khairul A.Comparison of the VBM laryngeal tube and laryngeal mask airway for ventilation during manual in-line neck stabilisation.Singapore Med J,2006,47(10):892-896.
[9] Ji YH,Yang XY,Wu J Q,et al.Nimotuzumab with cisplatin or fluorouracil on human esophageal squamous cell carcinoma EC1 cells. Eur Rev MedPharmacol Sci,2015,19(4):586-591.
[10] De Pietri L,Siniscalchi A,Reggiani A,et al.The use of intrathecal morphine for postoperative pain relief after liver resection:a comparison with epidural analgesia. Anesth Analg,2006,102(4):1157-1163.
[11] Liu JG,Zhao HJ,Liu YJ,et al.Effect of selenium-enriched malt on hepatocarcinogenesis,paraneoplastic syndrome and the hormones regulating blood glucose in rats treated by diethylnitrosamine.Life Sci,2006,78(20):2315-2321.
[12] Alwahaibi N,Mohamed J,Alhamadani A.Supplementation of selenium reduces chemical hepatocarcinogenesis in male Sprague-
Dawley rats.J Trace Elem Med Biol,2010,24(2):119-123.
[13] Chattopadhyay MB,C B MK,Kanna PS,et al. Combined supplementation of vanadium and beta-carotene suppresses placental glutathione S-transferase-positive foci and enhances antioxidant functions during the inhibition of diethylnitrosamine-induced rat liver carcinogenesis. J Gastroenterol Hepatol,2004,19(6):683-693.
[14] Rajeshkumar NV,Kuttan R.Inhibition of N-nitrosodiethylamine-induced hepatocarcinogenesis by Picroliv.J Exp Clin Cancer Res,2000,19(4):459-465.
[15] 刘伟. 不同浓度舒芬太尼与丙泊酚复合靶控输注应用于宫颈癌根治术的临床效果. 中国医药指南,2016,14(30):117-118.
[16] Ben Amara I,Fetoui H,Guermazi F,et al.Dietary selenium addition improves cerebrum and cerebellum impairments induced by methimazole in suckling rats.Int J Dev Neurosci,2009,27(7):719-726.
[17] Thirunavukkarasu C,Premkumar K,Sheriff AK,et al.Sodium selenite enhances glutathione peroxidase activity and DNA strand breaks in hepatoma induced by N-nitrosodiethylamine and promoted by phenobarbital.Mol Cell Biochem,2008,310(1):129-139.
[18] 曹焱,姜峰,张超,等. 肝动脉栓塞化疗联合CT引导精准微波消融治疗原发性肝癌患者疗效及对外周血T淋巴细胞亚群的影响. 实用肝脏病杂志,2017,20(4):468-471.
[19] Li D P,Li W,Feng J,et al.Adjuvant chemotherapy with sequential cytokine-induced killer(CIK) cells in stage IB non-small cell lung cancer. Oncol Res,2015,22(2):67-74.
[20] 陈亦蛟,梁敏,朱韵甜,等. 丙泊酚和七氟烷对腹腔镜结直肠癌根治术患者围手术期免疫功能的影响. 中华医学杂志,2015,95(42):3440-3444.
[21] Alwahaibi NY,Budin SB,Mohamed J,et al.Nuclear factor-kappa B as a promising target for selenium chemoprevention in rat hepatocarcinogenesis.J Gastroenterol Hepatol,2010,25(4):786-791.
[22] Dakshayani KB,Subramanian P,Manivasagam T,et al.Melatonin modulates the oxidant-antioxidant imbalance during N-nitrosodiethylamine induced hepatocarcinogenesis in rats.J Pharm Pharm Sci,2005,8(2):316-321.
[23] Golubnitschaja O,Yeghiazaryan K,Stricker H,et al.Patients with hepatic breast cancer metastases demonstrate highly specific profiles of matrix metalloproteinases MMP-2 and MMP-9 after SIRT treatment as compared to other primary and secondary liver tumours. Bmc Cancer,2016,16(1):357-368.
[24] Ramakrishnan G,Augustine TA,Jagan S,et al.Effect of silymarin on N-nitrosodiethylamine induced hepatocarcinogenesis in rats. Exp Oncol,2007,29(1):39-44.
[25] 汪威,林春水,张雅静,等. 丙泊酚对肿瘤细胞肺转移及E钙粘蛋白、β-连环蛋白表达的影响. 南方医科大学学报,2015,35(6):852-856.
[26] 张斌,黄翔,杨承祥,等. 丙泊酚对人PLC细胞株SMMC-7721细胞凋亡及VEGF和ICAM-1表达的影响. 广东医学,2012,33(20):3051-3053.
[27] 何永海,李学良,王力伟. 丙泊酚在高血压脑出血术中的应用效果评价. 实用临床医药杂志,2016,20(11):148-149.
[28] 尹兰英,郝玉苓,王岑,等. 生脉注射液对心脏瓣膜置换术丙泊酚全麻患者的心肌保护作用. 中医杂志,2016,57(8):686-689. [29] 姬雅君. 丙泊酚调控一氧化氮信号通路抗创伤后应激障碍的神经生物学研究. 河北北方学院,2015.
[30] 程勇,张晓庆. 丙泊酚对PLC患者围术期免疫功能的影响. 实用癌症杂志,2016,31(3):483-485.
[31] 任凌云,杨进国,曾文强. 七氟烷吸入和丙泊酚静脉维持对腹部手术老年患者免疫功能及血流动力学的影响. 细胞与分子免疫学杂志,2010,26(9):927-928.
[32] 徐艳冰. 丙泊酚通过下调ERK-VEGF/MMP-9信号通路抑制食管癌细胞增殖. 山东大学,2014.