脉冲式和恒等式镇痛对分娩后产妇T细胞亚群及Th1/Th2型细胞因子平衡的影响

Influence of Pulsed Injection and Identity Injection on Labor Analgesia Maternal T Cell Subsets and Th1/Th2 Cytokine Balance

目的:探讨脉冲式或恒等式注射镇痛方式对分娩后产妇T细胞亚群及Th1/Th2型细胞因子的影响。方法:行顺产分娩的孕产妇184例,根据镇痛注射方式不同分为脉冲组(n=96,采用脉冲式注射)和恒等组(n=96,采用恒等式注射),两组产妇分别于宫口开至2~3 cm(T1)和胎儿娩出(T2)时,空腹采集外周静脉血5 m L,用流式细胞仪技术测定产妇外周血T细胞亚群(CD3、CD4、CD8及CD4/CD8),用放射免疫法和酶联免疫吸附法分别检测皮质醇、白细胞介素-1β(IL-1β)和IL-10等Th1/Th2型细胞因子水平;记录两组产妇第一产程活跃期、第二及第三产程时间,记录胎儿娩出时的新生儿(Apgar)评分,宫口开至2~3 cm、宫口开全及胎儿娩出时产妇的疼痛视觉模拟(VAS)评分。结果:CD3+、CD4+及CD4/CD8比例随着两组产妇产程的进行均有明显降低(P<0.05),T2时点脉冲组产妇CD3+、CD4+及CD4/CD8明显低于恒等组(P<0.05),但两组产妇CD8+水平在同组两个观察时点及组间比较差异无统计学意义(P>0.05);与T1时点比较,脉冲组产妇T2时点的皮质醇、IL-1β水平升高,恒等组产妇T2时点的皮质醇、IL-10水平减低(P<0.05),其余指标变化不明显(P>0.05);脉冲组产妇T2时点的外周血皮质醇、IL-1β及IL-10水平均高于恒等组(P<0.05);恒等组产妇第一产程活跃期明显短于脉冲组(P<0.05),但两组第二、三产程的时间比较差异无统计学意义(P>0.05);宫口开全时和胎儿娩出时,恒等组产妇VAS评分明显低于脉冲组(P<0.05);两组新生儿Apgar评分比较差异无统计学意义(P>0.05)。结论:恒等式注射镇痛方式可明显减轻产程中疼痛等应激反应对产妇免疫功能的抑制,可维持适度Th1/Th2型细胞因子平衡。

Objective： To investigate the influence of pulsed injection and identity injection on labor analgesia maternal T cell subsets and Th1/Th2 cytokine balance. Methods： A total of 184 maternal who had natural labor were randomly divided into the pulsed group（ n = 96,treated with pulsed injection） and the identity group（ n = 96,treated with identity injection） according to injection methods for analgesia. C section of both groups were cut 2 to 3 cm to portio（ T1） and the baby was delivered（ T2）; 5 m L peripheral venous blood were collected while fasting; T cell subsets were determined by flow cytometry,and levels of Th1/Th2 cytokines such as cortisol,IL-1β and IL-10 were detected by radioimmunoassay and enzyme-linked immunosorbent assay. The time of different stages of labor,neonatal Apgar score when the baby was delivered,pain visual analogue scale（ VAS） at T1 when the cervix was open 2 to 3 cm,when the cervix was fully open and when the baby was delivered were recorded.Results： CD3 ＋,CD4 ＋ and CD4/CD8 proportion decreased significantly in both groups with the progress of labor（ P〈0. 05）. At T2,CD3 ＋,CD4 ＋ and CD4/CD8 were significantly lower in the identity group than the pulsed group（ P〈0. 05）. There was no significant difference in levels of CD8 ＋between two groups at T1 and group comparison（ P〈0. 05）. At T2,the levels of cortisol and IL-1βlevels were significantly higher in the pulsed group,the identity group showed decreased cortisol and IL-10 level（ P〈0. 05）,while the other indexes changed insignificantly. The active phase of the first stage of labor in the identity group was significantly shorter than the pulsed group（ P〈0. 05）,while comparison of time of second and third stage of both groups showed no statistical significance（ P〈0. 05）. Neonatal Apgar score of both groups showed no significant difference between the two groups（ P〈0. 05）. When the cervix was fully open,VAS scores of the identity group were significantly lower than the pulsed group（ P〈0. 05）. Conclusion： Identity injection of labor analgesia can significantly reduce immune suppression caused by labor pain and other stress responses and appropriately maintain Th1/Th2 cytokine balance.