地塞米松对原发性肝癌肝切除术患者肝功能血清炎症因子及免疫功能的影响

Effects of dexamethasone on liver function,serum inflammatory factors and immune function in patients with primary liver cancer after hepatectomy

目的观察地塞米松对原发性肝癌肝切除术患者肝功能、血清炎症因子及免疫功能的影响。方法将89例行肝癌肝切除术患者随机分为观察组47例和对照组42例。对照组给予常规治疗,观察组在常规治疗的基础上于围手术期给予地塞米松,每天10mg,连续应用3d。观察比较两组肝功能指标(ALT、AST、TBIL、ALP)、血清炎症因子(TNF-α、CRP、IL-8、IL-6)及免疫功能指标(CD3^+、CD4^+、CD8^+、CD4^+/CD8^+)变化情况。结果(1)两组ALT、AST、TBIL、ALP水平比较差异有统计学意义(F=5.237、5.842、4.376、4.496,均P<0.05);两组ALT、AST、TBIL随着时间的延长呈先升高后下降的趋势,而ALP呈先降低后升高(F=7.633、9.426、5.430、7.035,均P<0.05),且两组各指标变化趋势均存在显著差异(F=4.391、4.302、4.730、5.047,均P<0.05)。(2)两组TNF-α、CRP及IL-8、IL-6水平比较差异有统计学意义(F=7.393、8.452、6.627、5.611,均P<0.05),TNF-α、CRP及IL-8、IL-6随着时间的延长呈先升高后下降的趋势(F=12.493、13.455、8.247、7.621,均P<0.05),且两组各指标变化趋势均存在显著差异(F=6.305、6.747、4.632、5.508,P<0.05)。(3)两组CD3^+、CD4^+、CD8^+及CD4^+/CD8^+水平无明显不同(F=1.221、1.098、1.310、0.516,均P>0.05),随着时间的延长CD3^+、CD4^+、CD4^+/CD8^+水平表现出逐渐下降的趋势,而CD8^+逐渐升高(F=4.082、3.956、4.225、4.316,均P<0.05),且观察组与对照组变化幅度趋同(F=1.314、1.450、1.107、0.737,均P>0.05)。(4)观察组肠道功能恢复时间、住院时间均低于对照组,差异均有统计学意义(t=14.274、9.063,P<0.05);两组术后并发症发生率比较,差异无统计学意义(P>0.05)。(5)两组1、2年生存率比较,差异亦无统计学意义(P>0.05)。结论地塞米松短期、适量应用于肝癌肝切除术围手术期能起到确切的保肝、抗炎作用,有助于术后恢复,且不明显增加免疫抑制及术后并发症的发生。

Objective To observe the effects of dexamethasone on liver function, serum inflammatory factors and immune function in patients with primary liver cancer after hepatectomy. Methods 89 patient undergoing hepatectomy were randomly divided into the observation group （47 cases） and the control group （42 cases）. The control group was given conventional treatment, and the observation group was given additional dexamethasone 10 mg every day for 3 days based on conventional treatment. The differences of liver function （ALT, AST, TBIL, ALP）, serum inflammatory factors （TNFα, CRP, IL-6, IL-8）, immune function （CD3＋, CD4＋,CD8＋ and CD4＋/CD8＋） and postoperative morbidity between the two groups were compared. Results There were significant differences of ALT, AST, TBIL, ALP between the two groups （P＜0.05）. The levels of ALT, AST and TBIL in the two groups were showed first increasing then decreasing trends with increasing time, but ALP was on the contrary （P＜0.05）. The differences of those items in patients between the two groups were statistically different （P＜005）. There were significant differences of the levels of TNFα, CRP, IL-8、IL6 in patients between the two groups （P＜0.05）. All of those items in the two groups were showed first decreasing then decreasing trend with time （P＜0.05）, and the shifting trends of those items in patients between the groups were all statistically different （P＜0.05）. There were no significant differences of the CD3＋, CD4＋, CD8＋ and CD4＋/CD8＋ in patients between the two groups （P＜0.05）. CD3＋, CD4＋ and CD4＋/CD8＋ of the two groups were presented decreasing trend over time, but CD8＋ was on the opposite P＜0.05）. The shifting trend of those items in the patients between the two groups were not statistically different （P＞0.05）. The intestinal function recovery time and hospitalization time of the observation group were lower than those of the control group, with statistically significant difference （P＜0.05）. There were no significant differences in postoperative morbidity between the two groups （P＞0.05）. There were no statistically differences of the 1 year and 2 year survival rates in patients between the two groups （P＞0.05）. Conclusion The short term and proper application of dexamethasone can play an important role in protecting liver and antiinflammation in patients at the perioperative period of hepatectomy. It also helps to recuperation and dose not obviously increase the immunosuppression and postoperative morbidity.