腹腔镜直肠癌手术患者围术期焦虑和抑郁与其术后应激因子水平及免疫功能的相关性分析

Analysis of the correlation between perioperative anxiety and depression and levels of stress factors and immune functions in rectal cancer patients treated by laparoscopic surgery

目的分析腹腔镜直肠癌手术患者围术期焦虑和抑郁与其术后应激因子水平及免疫功能的相关性。方法选择2016年1月至2017年1月于本院行腹腔镜下直肠癌手术的107例患者为研究对象。术前采用焦虑自评量表(self-rating anxiety scale,SAS)和抑郁自评量表(self-rating depressive scale,SDS)对患者进行评分,评分≥50分者纳入试验组(54例),评分<50分者纳入对照组(53例),比较两组患者术前及术后1、4、7天外周血中应激因子[C反应蛋白(C-reactive protein,CRP)、热休克蛋白70(heat shock protein 70,HSP70)]和免疫相关因子[白细胞、中性粒细胞、CD4^+、CD8^+、CD4^+/CD8^+、白介素(interleukin,IL)-2、IL-6]水平。根据SAS、SDS评分将试验组患者分为轻度、中度及重度,比较不同程度焦虑和抑郁患者应激因子和免疫相关因子水平的变化情况。结果术后1天和4天,试验组患者外周血CRP水平显著高于对照组(P<0.05),HSP70水平显著低于对照组(P<0.05)。术后1、4、7天,两组患者白细胞水平、中性粒细胞百分比及CD8^+水平均无显著差异(P>0.05)。术后1、4、7天,试验组患者CD4^+、CD4^+/CD8^+、IL-2及IL-6水平均显著低于对照组(P<0.05)。Spearmen相关性分析显示,患者焦虑和抑郁程度与其CRP、HSP70水平均呈正相关,与CD4^+、CD4^+/CD8^+、IL-2、IL-6水平均呈负相关。结论腹腔镜直肠癌手术患者围术期焦虑和抑郁状态会增强其术后的应激炎性反应并降低其免疫功能,焦虑和抑郁程度与CRP、HSP70水平呈正相关,与CD4^+、CD4^+/CD8^+、IL-2及IL-6水平呈负相关。

Objective To analyze the correlation between perioperative anxiety and depression and levels of stress factors and immune functions in rectal cancer patients treated by laparoscopic surgery.Method From January 2016 to January 2017,107patients underwent laparoscopic surgery for rectal cancer were enrolled for the study.According to the score of self rating anxiety scale（SAS）and self rating depression scale（SDS）,patients were divided into experimental group（score≥50,n=54）and control group（score〈50,n=53）.The levels of C-reactive protein（CRP）,heat shock protein 70（HSP70）,and leukocyte,neutrophil percentage,CD4^＋,CD8^＋,CD4^＋/CD8^＋,IL-2 and IL-6 of the two groups were compared before and 1 d,4 d,7 d after operation.According to the SAS and SDS scores,patients in experimental group were divided into mild,moderate and severe cases,and the levels of stress factors and immune functional substances in patients with different degrees of anxiety and depression were compared.Result The CRP level of experimental group was higher than that in control group at 1 d,4 d after operation（P〈0.05）,while the HSP70 levelwas lower than that in control group（P〈0.05）.There were no significant difference in levels of leukocyte,neutrophil percentage and CD8^＋between the two groups（P〉0.05）.The levels of CD4^＋,CD4^＋/CD8^＋,IL-2 and IL-6 of experiment group were significantly lower than those in control group at 1 d,4 d and 7 d after operation（P〈0.05）.Spearmen correlation analysis showed that anxiety and depression were positively correlated with CRP and HSP70 levels,and which was negatively correlated with CD4^＋,CD4^＋/CD8^＋,IL-2 and IL-6levels.Conclusion Perioperative anxiety and depression in patients undergoing laparoscopic surgery for rectal cancer will increase their postoperative stress inflammatory response and reduce their immune function.The degree of anxiety and depression is positively correlated with the levels of CRP,HSP70,while is negatively correlated with the levels of CD4^＋,CD4^＋/CD8^＋,IL-2 and IL-6.