1,6-二磷酸果糖对乳腺癌根治术患者外周血Th细胞极化的影响

Effect of Fructose-1,6-bisphosphate on Th1 and Th2 Cell Polarization in Patients Undergoing Breast Cancer Surgery

目的探讨1,6-二磷酸果糖(F-1,6-2P)对乳腺癌根治术患者围术期细胞免疫的影响.方法择期行乳腺癌根治术患者60例,年龄36～69岁,ASAⅠ或Ⅱ级,随机分为C组(NS,n=30)和F组(FDP,n=30).C组为对照组,于麻醉前静脉输注生理盐水(NS)4 mL/kg;F组为实验组,静脉输注1,6-二磷酸果糖250 mg/kg.两组麻醉方法及麻醉用药相同.于给药前、术毕及术后第5天采外周静脉血3 mL,采用流式细胞仪测定细胞因子IFN-γ、TNF-α、IL-2、IL-4、IL-5和IL-10及Th1/Th2比值.结果与正常值相比,两组患者用药前各细胞因子升高(P<0.01),两组间差异无统计学意义(P>0.05);与术前相比,对照组术毕Th2型细胞因子IL-10升高(P<0.01),实验组Th1型细胞因子升高(P<0.01);与术前相比,对照组术毕Th1/Th2比值下降,实验组上升(P<0.01),组间相比(P<0.01);术后第5天两组各项指标均恢复到术前水平.结论静脉输注1,6-二磷酸果糖后可增加乳腺癌根治术患者外周血Th1型细胞因子水平,Th1/Th2平衡向Th1细胞免疫反应偏移,机体细胞免疫功能增强.

Objective To investigate the influence of fructose-1, 6-bisphosphate on Th1 and Th2 cell polarization in patients undergoing breast cancer surgery. Methods Sixty ASA Ⅰ or Ⅱ patients aged 36-69 yr undergoing breast cancer surgery were randomly assigned to one of 2 groups （ n = 30 each） ： The control group（C） and fructose-1, 6-bisphosphate group（F）, patients in F group received fructose-1, 6-bisphosphate 250 mg/kg intravenously 15 min before anesthesia induction. Anesthesia was induced with midazolam, fentanyl, etodamate and vecuronium and maintained with propofol and remifentanyl infusion and intermittent Ⅳ boluses of vecuronium in both groups. Blood samples were taken before intravenous fructose-1, 6-bisphosphate , after the end of operation and the fifth day after surgery for determination of serum levels of IFN-γ , TNF- α , IL-2, IL-4, IL-5 and IL-10 and serum levels of Th1, Th2 cell and Th1/Th2 ratio. Results Before intravenous fructose-1, 6-bisphosphate, the serum levels of cytokine-dependent Th 1 and Th2 were higher than normal in two groups （P 〈 0.01 ）. There was no significant difference between significantly after the end of operation as compared the two groups. Cytokine-dependent Th2 increased with the baseline before intravenous fructose-1, 6-bisphosphate in the control group （P 〈 0.01）. Cytokine-dependent Th1 increased singnificantly after the end of operation as compared with the baseline before intravenous fructose-1, 6-bisphosphaten in the fructose-1, 6-bisphosphaten grupe. The Th1/Th2 ratio decreased in the control group while the Th1/Th2 ratio increased in the fructose-1, 6-bisphosphaten, and there was significant difference between the two groups （P 〈 0.01）. The levels of cytokine recovered to the baseline before operation at the fifth day after operation in the two groups. Conclusions There is imbalance of cytokine-dependent Th1 and Th2 cell before operation, and the Th1/Th2 balance moves toward the Th2 direction. The FDP can increase the level of cytokine-dependent Th1, and improve cell immunity function.