舒芬太尼硬膜外镇痛对重度子痫前期患者剖宫产术后外周血中IL-17和Foxp3表达的影响

Effects of sufentanil epidural analgesia on the expression of IL-17 and Foxp3 in the peripheral blood of patients with severe preeclampsia after cesarean section

目的:探讨舒芬太尼硬膜外镇痛对重度子痫前期患者剖宫产术后外周血中白细胞介素17(interleukin-17,IL-17)和叉头状螺旋转录因子3(Forkhead box p3,Foxp3)表达水平的影响。方法:选择欲行子宫下段剖宫产手术的子痫前期患者60例,术中采用蛛网膜下腔-硬膜外腔联合阻滞麻醉(combined spinal epidural anesthesia,CSEA),术后给予镇痛。患者随机分成3组,每组20例,分别为R组:0.15%罗哌卡因;RS组:0.125%罗哌卡因复合舒芬太尼0.5μg/m L,以上两组硬膜外泵自控镇痛;C组:地佐辛10 mg加入100 m L生理盐水静滴,qd×2 d。双抗夹心酶联免疫吸附法(enzymelinked immunoabsorbent assay,ELISA)检测麻醉开始即刻(T_0),术后6 h(T_1)、12 h(T_2)、24 h(T_3)、48 h(T_4)患者外周血中IL-17和Foxp3表达水平。T1、T_2、T_3、T_4对患者进行视觉模拟疼痛评分(visual analogue pain scale,VAS)。结果:R组和RS组T1、T2、T_3、T_4时VAS评分明显低于C组(P<0.05),RS组T_1、T_2、T_3时VAS评分明显低于R组(P<0.05)。3组患者T_1较T_0时IL-17水平明显升高、Foxp3水平明显降低(P<0.05),T2、T3、T4较T1时IL-17水平逐渐减低、Foxp3水平逐渐升高。C组,T_4较T_2、T_3时IL-17水平明显降低、Foxp3水平明显升高(P<0.05);T4较T0时IL-17水平明显升高、Foxp3水平明显降低(P<0.05)。R组、RS组,T_3较T_2时,T_4较T_0、T_2、T_3时IL-17水平明显降低、Foxp3水平明显升高(P<0.05)。T3、T4,RS组较R组和C组,R组较C组IL-17水平明显降低、Foxp3水平明显升高(P<0.05)。结论:舒芬太尼硬膜外镇痛有效而明显地调控IL-17和Foxp3的表达,能缓解剖宫产术后重度子痫前期的病情,改善患者预后。

Objective:To investigate the effect of sufentanil epidural analgesiaon the expression of interleukin-17(IL-17)and Forkhead box p3(Foxp3)in the peripheral blood of patients with severe preeclampsia after cesarean section.Methods:Sixty cases of severe preeclampsia patients undergoing cesarean section,were treated with combined spinal epidural anesthesia(CSEA)and postoperative analgesia.Patients were randomly divided into three groups(n=20).R group:0.15%ropivacaine;RS group:0.125%ropivacaine with sufentanil 0.5μg/mL,in the two groups patient controlled epidural analgesia.C group:dezocine 10 mg with 100 mL of saline were infused,qd×2 days.Plasma levels of IL-17 and Foxp3 were measured when anesthesia began immediately(T0)and at 6,12,24,48 h after the operation(T1,T2,T3,T4)by the enzyme-linked immunoabsorbent assay(ELISA)method.Visual analogue pain scale(VAS)scores were recorded at T1,T2,T3,T4.Results:The VAS score of R group and RS group was significantly lower than that of group C at T1,T2,T3,T4(P<0.05).The VAS score of RS group was significantly lower than that of group R at T1,T2,T3,T4(P<0.05).In the three groups,IL-17 level increased significantly and Foxp3 level decreased significantly at T1 than T0(P<0.05).IL-17 level gradual decline and Foxp3 level gradual advance at T2,T3,T4 than T1.In group C,IL-17 level decreased significantly and Foxp3 level increased significantly at T4 than T2,T3(P<0.05),IL-17 level increased significantly and Foxp3 level decreased significantly at T4 than T0(P<0.05).In group R and group RS,compared with T2,IL-17 level decreased significantly and Foxp3 level increased significantly at T3;compared with T0,T2 and T3,IL-17 level decreased significantly and Foxp3 level increased significantly at T4(P<0.05).At T3 and T4,compared with group R and group C,IL-17 level decreased significantly and Foxp3 level increased significantly in RS group;compared with group C,IL-17 level decreased significantly and Foxp3 level increased significantly in R group(P<0.05).Conclusion:Sufentanil epidural analgesia can effectively and efficiently regulate the expression of IL-17 and Foxp3,relieve the severity of severe preeclampsia and improve the prognosis after cesarean section.