摘要
目的探讨术中低体温对非肌层浸润性膀胱癌(NMIBC)患者术后免疫功能和远期复发的影响。方法试验设计属于前瞻性研究,以2015年1月至2019年12月期间符合条件的337例NMIBC患者为研究对象。根据术中最低体温36℃为界将患者分为低体温组和对照组。于麻醉诱导前1 h(T0)、手术结束时(T1)及术后24 h(T2)抽取外周静脉血检测Thl/Th2型细胞内细胞因子。长期随访以电话随访为主,失效事件为膀胱癌复发。结果337例参与者中,158例(46.9%)患者出现术中低体温。与对照组相比,低体温组T1时的IFN-γ水平和IFN-γ/IL-4显著降低,低体温组T2时的IFN-γ水平和IFN-γ/IL-4显著降低,而IL-4水平显著升高。对照组有102例出现膀胱癌复发,无复发生存时间为15(3~48)个月;低体温组有97例出现膀胱癌复发,无复发生存时间为12(3~60)个月,两组之间无复发生存曲线差异无统计学意义(χ^(2)=0.533,P=0.465)。对于T1期患者,对照组有28例出现膀胱癌复发,无复发生存时间为10.5(3~48)个月;低体温组有36例出现膀胱癌复发,无复发生存时间为10.5(3~45)个月,两组之间的无复发生存曲线差异有统计学意义(χ^(2)=5.261,P=0.022)。对于非T1期患者,对照组有74例出现膀胱癌复发,无复发生存时间为15(3~48)个月;低体温组有61例出现膀胱癌复发,无复发生存时间为12(3~60)个月,两组之间的无复发生存曲线差异无统计学意义(χ^(2)=0.199,P=0.656)。多因素Cox回归分析表明术中低体温是影响复发的独立危险因素之一[HR:1.153(1.055~3.984),P=0.039]。结论术中低体温能抑制NMIBC患者术后的细胞免疫功能,并且是T1期患者术后复发的危险因素之一,术中保温对于进一步改善NMIBC患者的预后具有一定的意义。
Objective To explore the effect of intraoperative hypothermia on postoperative immune function and long-term recurrence in patients with non-muscle invasion bladder cancer(NMIBC).Methods This study was a prospective study which included 337 NMIBC patients meeting the conditions between January 2015,and December 2019.Patients were divided into hypothermia group and control group according to the lowest body temperature(36℃)during operation.Peripheral venous blood was taken to detect Thl/Th2 intracellular cytokines at 1 h before induction of anesthesia(T0),the end of surgery(T1)and 24 h after operation(T2).The main form of follow-up was telephone follow-up.Endpoint was bladder cancer recurrence.Results Of the 337 participants,158 cases(46.9%)showed intraoperative hypothermia.Compared with the control group,the hypothermia group had a significantly lower level of IFN-γand IFN-γ/IL-4 at T1,and a significantly lower level of IFN-γand IFN-γ/IL-4 and a significantly higher level of IL-4 at T2.In the control group,102 patients had recurrence of bladder cancer,and the recurrence-free survival time was 15(3-48)months.In the hypothermia group,97 patients had bladder cancer recurrence,and the recurrence-free survival time was 12(3-60)months.There was no significant difference in the recurrence-free survival curve between the 2 groups(χ^(2)=0.533,P=0.465).For patients with T1,28 patients had recurrence of bladder cancer,and the recurrence-free survival time was 10.5(3-48)months in the control group,36 patients had recurrence of bladder cancer,and the recurrence-free survival time was 10.5(3-45)months in the hypothermia group.There was a significant difference in the recurrence-free survival curves between the 2 groups(χ^(2)=5.261,P=0.022).For non-T1 patients,74 patients had bladder cancer recurrence in the control group,and the recurrence-free survival time was 15(3-48)months.61 patients had bladder cancer recurrence in the hypothermia group,and the recurrence-free survival time was 12(3-60)months.There was no significant difference in the recurrence-free survival curve between the 2 groups(χ^(2)=0.199,P=0.656).Multivariate Cox regression analysis showed that intraoperative hypothermia was one of the independent risk factors for recurrence[HR:1.153(1.055-3.984),P=0.039].Conclusions Intraoperative hypothermia inhibits postoperative cellular immune function in patients with NMIBC is one of risk factors for postoperative recurrence in NMIBC patients with T1.Intraoperative warming has a certain significance for further improving the prognosis of patients with NMIBC.
作者
杨红霞
龙喜花
罗朝霞
Yang Hongxia;Long Xihua;Luo Zhaoxia(Department of Urology,Qinghai University Affiliated Hospital,Qinghai 810001,China)
出处
《中华腔镜泌尿外科杂志(电子版)》
2021年第5期396-400,共5页
Chinese Journal of Endourology(Electronic Edition)
基金
青海大学附属医院科学创新基金项目(FYXC-2017-04)。
关键词
膀胱癌
低体温
免疫功能
复发
前瞻性研究
Bladder cancer
Hypothermia
Immune function
Recurrence
Prospective study