腹腔镜与开腹直肠癌术后应激反应期ghrelin的动态变化及意义

Stress response-related changes of ghrelin in rectal cancer patients after laparoscopic or open surgery

目的 ghrelin作为一种新发现的胃肠激素在炎症和应激反应中的潜在作用尚未明确。研究旨在了解不同手术操作所致围手术期外周循环ghrelin的特征性变化,以及与炎性细胞因子相关性及与应激中的调节作用。方法前瞻性随机对照试验,选取44例直肠癌患者随机分配至开腹手术组(对照组=22例)和腹腔镜手术组(实验组=22例),记录手术时间、术中失血量、住院天数和术后肠功能恢复时间,术前及手术开始后6、12、24、36、48、72 h测定血清中ghrelin、C-反应蛋白(C-reactive pro-tein,CRP)、皮质醇、肿瘤坏死因子(tumor necrosis factor,TNF)、IL-6、IL-8、α-1抗胰蛋白酶(alphao-antitrypsin,AAT)水平。结果 2组患者手术学指标比较均有统计学意义(P<0.05)。术后24 h 2组血清ghrelin水平均显著升高,对照组显著高于术前(P<0.01)和试验组峰值水平(P<0.05),2组ghrelin于术后36～48 h降至术前水平。除皮质醇外,2组其他试验参数术后峰值比较均有统计学意义(P<0.05)。术后24h ghrelin与TNF-α相关系数最高(r=0.64,P<0.05),与IL-6也存在相关性(r=0.56,P<0.05)。结论应激反应会导致血浆中ghrelin水平升高,其反应程度依赖于炎性反应的刺激强度。

Objective The potential roles of ghrelin in inflammation and stress response are not yet clear. This study aimed to characterize the perioperative levels of ghrelin related to different surgical procedures and investigate its regulatory effect on stress re- sponse and its correlation with inflammatory cytokines. Methods We conducted a prospective randomized controlled trial, assigned 44 rectal cancer patients to receive open surgery （control, n = 22） and laparoscopic surgery （experimental, n = 22）. We recorded the opera- tion time, intraoperative blood loss, length of hospital stay and length of bowel function recovery, and measured the levels of ghrelin, C-reactive protein, TNF-ct, cortisol, IL-6, IL-8 and ct-1 antitrypsin before and at 6, 12, 24, 36, 48 and 72 hours after surgery. Results There were statistically significant differences in operation indicators between the two groups （P 〈 0.05 ）. Blood sample analysis exhibited an elevation of ghrelin in both groups at 24 hours after the start of surgery, significantly higher than both the preoperative level in the control group （P 〈0.01 ） and the maximal postoperative level in the experimental group （P 〈0.05 ）. The ghrelin concentration re- turned to the preoperative level at 36 -48 hours after surgery. The maximal postoperative levels of all the parameters obtained but cortisol0. 56, P 〈 0. 05 ）. Conclusion Stress response can lead to an increased level of ghrelin in the plasma, and its intensity depends on the that of the inflammatory stress stimulus.