全凭静脉麻醉和吸入麻醉对恶性肿瘤患者术后早期免疫功能和复发转移影响的Meta分析

Meta-analysis of the effects of total intravenous anesthesia and inhalation anesthesia on early postoperative immune function,recurrence and metastasis in patients with malignant tumors

目的通过Meta分析比较全凭静脉麻醉和吸入麻醉对恶性肿瘤患者术后早期免疫功能和复发转移的影响。方法计算机检索2010年1月至2020年1月PubMed、Embase和Cochrane Library等数据库,收集恶性肿瘤患者采用全凭静脉麻醉和吸入麻醉进行手术治疗的随机对照试验,采用RevMan 5.3和STATA 15.0软件分析两种麻醉方法对恶性肿瘤患者术后早期免疫功能指标[白细胞介素(IL)-6、IL-10、转化生长因子(TGF)-β、血管内皮生长因子(VEGF)-C和自然杀伤(NK)细胞]和肿瘤复发转移的影响。结果共纳入8篇文献,665例患者。Meta分析结果显示,与吸入麻醉相比,全凭静脉麻醉可明显降低恶性肿瘤患者术后IL-6、TGF-β和VEGF-C水平(SMD=-0.35、-0.26和-0.64,95%CI-0.58~-0.12、-0.49~-0.02和-0.99~-0.28,P<0.01或<0.05);两种麻醉方法对恶性肿瘤患者术后IL-10和NK细胞无影响(SMD=0.16和0.18,95%CI-0.07~0.39和-0.23~0.60,P>0.05);两种麻醉方法对恶性肿瘤患者术后肿瘤复发和转移无影响(RR=0.70,95%CI 0.47~1.03,P=0.07)。结论全凭静脉麻醉可能通过降低促癌因子IL-6、TGF-β和VEGF-C的水平而提高恶性肿瘤患者术后早期的免疫功能,但全凭静脉麻醉对降低恶性肿瘤患者术后肿瘤复发和转移的影响不明显。

Objective To compare the effects of total intravenous anesthesia and inhalation anesthesia on early postoperative immune function,recurrence and metastasis by Meta-analysis in patients with malignant tumors.Methods The PubMed,Embase and Cochrane Library were searched by computer from January 2010 to January 2020.The randomized controlled trials of surgical treatment using total intravenous anesthesia or inhalation anesthesia in patients with malignant tumors were collected.The RevMan 5.3 and STATA 15.0 softwares were used to analyze the impact of 2 anesthesia methods on early postoperative immune function indexes and tumor recurrence and metastasis in patients with malignant tumors.The immune function indexes included interleukin(IL)-6,IL-10,transforming growth factor(TGF)-β,vascular endothelial growth factor(VEGF)-C and natural killer(NK)cell.Results A total of 8 articles were included,with a total of 665 patients.Meta analysis results show that,compared with inhalation anesthesia,total intravenous anesthesia could significantly reduce the levels of IL-6,TGF-βand VEGF-C in patients with malignant tumors after surgery(SMD=-0.35,-0.26 and-0.64;95%CI-0.58 to-0.12,-0.49 to-0.02 and-0.99 to-0.28;P<0.01 or<0.05);the 2 anesthesia methods had no significant effect on IL-10 and NK cell in patients with malignant tumors after surgery(SMD=0.16 and 0.18,95%CI-0.07 to 0.39 and-0.23 to 0.60,P>0.05);and the 2 anesthesia methods had no significant effect on tumor recurrence and metastasis in patients with malignant tumors(RR=0.70,95%CI 0.47 to 1.03,P=0.07).Conclusions Total intravenous anesthesia may improve the early postoperative immune function in patients with malignant tumor by reducing the levels of pro-cancer factors IL-6,TGF-βand VEGF-C,but total intravenous anesthesia has no obvious effect on reducing postoperative tumor recurrence and metastasis in patients with malignant tumor.