右美托咪定对消化道恶性肿瘤患者围手术期T淋巴细胞亚群与NK细胞免疫功能的Meta分析

Effectiveness of Dexmedetomidine for Cellular Immune Function of Gastrointestinal Cancer Patients Accepted Operation:A Meta-Analysis

目的分析右美托咪定辅助全身麻醉对消化道恶性肿瘤患者围手术期T淋巴细胞亚群与NK细胞免疫功能的影响。方法计算机检索Cochrance图书馆、MEDLINE、EMBASE、OVID、Pub Med、超星外文数据库和中文数据库、中国生物医学文献光盘数据库、CNKI、万方数据库。收集关于研究消化道恶性肿瘤患者围手术期使用右美托咪定辅助全身麻醉对细胞免疫功能的随机和半随机对照试验,并评价纳入研究的方法学质量,采用Rev Man 5.2软件进行Meta分析。结果共纳入5个RCT研究,包括220例患者。分析显示:消化道恶性肿瘤患者接受手术后两组T淋巴细胞和NK细胞水平均较术前有不同程度下降,右美托咪定辅助麻醉的患者仅在术毕至术后72小时CD3+T与CD4+T淋巴细胞亚群较对照组高、术毕与术后24小时CD4+/CD8+均较对照组高、术后72小时CD8+T淋巴细胞亚群水平亦较对照组高,差异有统计学意义(P<0.05)。术毕与术后24小时右美托咪定组患者NK细胞水平较对照组高,差异有统计学意义(P<0.05)。结论右美托咪定辅助全身麻醉可以相对性的提高消化道恶性肿瘤患者术后机体细胞免疫功能,但其具体机制尚不清楚;目前还没有证据证明右美托咪定能改善消化道恶性肿瘤患者术后的整体预后,有待大样本、多中心的临床研究加以证实。

Objective To evaluate the effectiveness of using dexmedetomidine in general anesthesia for cellular immune functionof gastrointestinal cancer patients who accepted operation. Methods The specialized trials registered in Cochrane Library,MED-LINE,EMbase,OVID,Pub Med,Chao xing foreige language and Chinese database,Chinese biomedical literature disc,CNKI data-base and Wanfang database were all searched. Randomized controlled trials and quasi-randomized trials that was about effectivenessof using dexmedetomidine combined with general anesthesia to gastrointestinal cancer patients were included.The quality of trials wasassessed strictly. Rev Man 5.2 software was used for data analysis. Result Five randomized trials involving 220 patients were includ-ed. Meta-analyses showed the following results. T lymphocytes and NK cell levels of all patients were declined after operation. CD3＋Tand CD4＋T lymphocytes levels at dexmedetomidine group were higher than those at control group from postoperation to 72 h postopera-tion. And CD4＋/CD8＋ levels after operation and those on 24 hours postoperation,CD8＋T lymphocyte levels on 72 h postoperation werehigher than those at control group（P〈0.05）.The NK cell was also higher in dexmedetomidine groups on postoperation and 24 h postoper-ation（P〈0.05）. Conclusion Dexmedetomidine being used in general anesthesia can improve immune function of patients with gas-trointestinal cancer,but the mechanism is not clear. Now there is no evidence that dexmedetomidine can improve overall prognosis ofmalignant tumor patients after operation. More samples and multi center studies are required to confirmed it.