消化系统恶性肿瘤患者手术前后外周血应激指标水平的变化及其意义

Clinical Significance of Changes on Peripheral Blood Levles of Related Stress Indicators in Patients with Digestive Malignancies

目的:研究消化系统恶性肿瘤手术患者外周血相关应激指标的变化,探讨术前药物及心理护理干预的必要性。方法:血清皮质醇(Cortisol)、促甲状腺素(thyroid stimulating hormone,TSH)、生长激素(growth hor-mone,GH)、白介素-6(interleukin-6,IL-6)、IL-8和肿瘤坏死因子-α(tumorne corsisfactor-α,TNF-α)均采用放射免疫分析;血浆对氧磷酶-1(parnase-1,PON-1)、过氧化脂质(lipid peroxidation,LPO)和谷胱甘肽过氧化物酶(glutathioneperoxidase,GPX)测定采用生化分析法。结果:①内分泌系统血清学指标的变化:患者术前24h组,血清Cortisol、TSH和GH水平均略高于正常对照组,但无统计学差异(P>0.05),然麻醉前组血清上述三项指标水平均显著高于术前24h组及正常对照组(P均<0.05),术后24h组则升高更为显著(P均<0.01、P<0.05)。②免疫系统血清学指标的变化:术前24h组和麻醉前组三项炎性细胞因子中TNF-α水平较正常对照组增高显著(P均<0.05),IL-6和IL-8均无统计学差异(P均>0.05),术后24h组三项炎性细胞因子水平均显著高于术前24h组和麻醉前组(P均<0.05)。③患者围手术期氧化应激系统血清学指标的变化:血浆PON-1和GPX水平结果显示,三组患者两项氧化应激指标均显著低于正常对照组(P均<0.05,P<0.01),术后24h组PON-1水平低于术前24h组和麻醉前组(P均<0.05)。LPO水平则均显著高于术前24h组和麻醉前组(P均<0.05),GPX水平与术前24h组和麻醉前组比较无显著统计学差异(P>0.05)。结论:血清Cortisol、TSH、GH和氧化应激指标水平显著升高,表明患者在术前的确存在心理应激和氧化应激病理反应,需要实施术前药物及心理护理干预。

Objective To measured and analysis the changes of peripheral blood of related stress indicators in patients with gastrointestinal malignancies and discuss its necessity on implement intervention of pharmacological and psychological care before operation.Method Serum levels of cortisol,TSH,GH,IL-6,IL-8 and TNF-α levels were measured with RIA.Plasma PON-1,LPO and GPX levels were measured with automatic biochemical analysis both before and after operation in 50 patients with gastrointestinal malignancies as well as 45 healthy normal controls.Results ①The serum levels of cotisol,TSH and GH in the patients 24 h before operation were slightly,but not significantly higher than the controls（all P 0.05）,the group of before anaesthesia,three target serum levels showed all significantly increased more and markedly higher than those in controls（P 0.05）.Post-operation the serum levels of the 3 hormones increased farther by 24 h,were very distinctly higher than those in controls（all P 0.01）.② Serum levels of immunological parameters displayed,the serum levels of IL-6 and IL-8 in the patients 24 h before operation and before anesthesia expressed but not significantly higher than the controls（all P 0.05）,but the serum level of TNF-α presented significantly increased and higher than that in controls（P 0.05）.Post-operation the serum levels of the 3 immunological parameters increased farther by 24 h,were very significantly higher than those in controls（all P 0.01）,and Post-operation the serum levels of the 3 immunological parameters were all significantly higher by 24h,manifested significantly higher than the group of 24h before operation and the group of before anaesthesia（all P 0.05）.③ The oxidative stress indicators expressed in patients,the Plasma LPO level of the 24h before operation,right the before anaesthesia and 24 h after Post-operation were all significantly higher than those in controls（P 0.05,P 0.01）.The plasma LPO level was increased farther than that in right the before anesthesia and before the 24h operation group（P 0.01,P 0.05）.Conclusion psychological and oxidative stress reaction is evident existed in the patients before operation with significantly increase of serum levels of Cotisol,TSH,GH,PON-1,and GPX.It is necessary to implement pharmacological and psychological care interventions before operation.