丙泊酚对肺癌患者外周血IL-12、IFN-γ及IL-4的影响

Effects of propofol on peripheral IL-12,IFN-γ and IL-4 in lung cancer patients

目的探讨丙泊酚对肺癌患者外周血细胞因子白细胞介素(IL)-12、γ-干扰素(IFN-γ)、IL-4的影响。方法30例行非小细胞型肺癌肺叶切除术患者随机分为丙泊酚(IV)组和异氟醚(IH)组,每组15例。分别于麻醉诱导前(T0)、麻醉诱导后10min(T1)、切皮后1h(T2)、停药即刻(T3)、术后1h(T4)及术后24h(T5)采集肘静脉血,测定血清IL-12、IFN-γ、IL-4及皮质醇(Cor)浓度。结果与T0时比较,IV组T5时IL-12、IFN-γ/IL-4及T4、T5时IFN-γ明显增高(P<0.05或P<0.01);且T5时IL-12、IFN-γ/IL-4及T4、T5时IFN-γ均高于IH组(P<0.05)。两组IL-4均有增高趋势,但组内、组间差异无显著意义。与T4时相比,T5时IV组IFN-γ、IFN-γ/IL-4增高明显(P<0.05)。结论丙泊酚可以促进外周血IL-12、IFN-γ的分泌,升高IFN-γ/IL-4比值,诱导围术期Ⅰ型辅助性淋巴细胞(Th1)反应,有利于抗肿瘤、抗感染免疫。

Objective To investigate the effects of propofol on IL-12,IFN-γand IL-4 of peripheral lymphocytes in non-small-cell lung cancer patients. Methods Thirty patients scheduled for pulmonary lobectomy were randomly allocated to two groups with 15 cases each. Anesthesia was induced with propofol 2 mg/kg and ma!ntained with propofol 7.81±2.19 mg·kg^-1·h^-1in group IV, and with etomidate 0. 3 mg/kg and maintained with isoflurane in group IH. Venous blood samples were taken for the measurements of serum IL-12, IFN-γ, IL-4 concentrations （ELISA） and cortisol levels （RIA） before induction（T0 ）, at 10 mir, after induction（T1 ）, 1h post-incision（T2 ）, stopping anesthetics administration （T3）, 1h （T4）and 24 h （T0） after operation. Results At T5, IL-12 showed a significant increase in group IV（P〈0.05）compared with that at To, while in group IH no significant change was found. Compared with To, IFN-γ in group IV increased significantly at 1 and 24 h after operation（P〈0.01）, which were significantly higher than that in group IH（P〈0.05）. Compared with T4, IFN-γ in group IV at T5 showed a significant increase（P〈0.05）. Increased serum IL-4 levels were found in hoth groups, hut there was no significant difference. Compared with T0 and T4, IFN-γ/IL-4 ratio in group IV showed a significant increase at T5 （P〈0.05）, which was not in group IH. Serum cortisol levels increased significantly in both groups from T1 to T5 （P〈0.05 or P〈0.01）, and there was a more significant increase in group IH compared with that in group IV（P〈0.05）. Conclusions Propofol exerts a positive effect on the secretion of IL-12, IFN-γ and IL-4 in peripheral blood and assists Thl cells activation and differentiation. Propofol attenuates the surgical stressinduced adverse immune responses and benefits the perioperative antitumor and antiinfection activity in lung cancer patients.