全凭静脉麻醉和全凭吸入麻醉对乳腺癌患者围手术期外周血CD4^(+)CD25^(+)Foxp3^(+) 调节性T细胞及相关细胞因子的影响

Effects of total intravenous anesthesia and total inhalation anesthesia on CD4^(+)CD25^(+)Foxp3^(+) Treg cells and related cytokines in peripheral blood of breast cancer patients during perioperative period

目的评价全凭静脉麻醉和全凭吸入麻醉对浸润性乳腺癌患者围手术期外周血辅助性T细胞亚型及相关细胞因子[IL17A、干扰素γ(interferonγ,IFNγ)、IL6、IL10]的影响。方法选择常德市第一人民医院浸润性乳腺癌患者60例,ASA分级Ⅰ、Ⅱ级,年龄35~75岁,肿瘤TNM分期Ⅰ、Ⅱ级,BMI 18.5~28.0 kg/m^(2),按随机数字表法分成丙泊酚全凭静脉麻醉组(静脉组)和七氟醚吸入麻醉组(吸入组),每组30例。麻醉诱导:静脉组选用咪达唑仑0.04 mg/kg,芬太尼6μg/kg,丙泊酚1.5~2.0 mg/kg,苯磺酸顺阿曲库铵0.3 mg/kg;吸入组选用依托咪酯0.2 mg/kg替代丙泊酚,其余诱导用药同静脉组。静脉组采用微量泵靶控输注(targetcontrolled infusion,TCI)模式持续输注丙泊酚维持麻醉,靶控浓度3~4 mg/L;吸入组持续吸入1.5%~2.0%浓度的七氟醚;维持BIS 40~60。两组患者分别于入手术室后麻醉诱导前(D0,术前)、术后第1天(D1)、术后第3天(D3)采集外周静脉血3 ml,流式细胞仪检测外周血中CD4^(+)CD25^(+)Foxp3^(+)调节性T细胞绝对计数及相对计数,流式液相多重蛋白定量法检测血浆中IL17A、IFNγ、IL6和IL10浓度。结果与D0比较:两组患者D1外周血中CD4^(+)CD25^(+)Foxp3^(+)调节性T细胞绝对计数及相对计数降低,IL17A、IL6浓度升高,差异有统计学意义(P<0.05);D3时均基本恢复至D0水平。与吸入组比较:静脉组患者D1时IL17A、IL6浓度较低(P<0.05),其余指标相同时间点组间比较差异无统计学意义(P>0.05)。结论丙泊酚全凭静脉麻醉和七氟醚全凭吸入麻醉对乳腺癌改良根治术患者围手术期外周血CD4^(+)CD25^(+)Foxp3^(+)调节性T细胞的含量无明显影响;相较于全凭吸入麻醉,全凭静脉麻醉可抑制IL17A、IL6的过度表达,可能有利于减轻乳腺癌患者围手术期炎性反应。

Objective To evaluate the effect of full intravenous anesthesia and full inhalation anesthesia on peripheral blood helper T cell subtypes and their related cytokines[interleukin(IL)17A,interferonγ(IFNγ),IL6 and IL10]in patients with invasive breast cancer during perioperative period and the perioperative outcome.Methods According to the random number table method,sixty patients with invasive breast cancer,American Society of Anesthesiologists(ASA)Ⅰ‒Ⅱ,aged 35‒75,TNM stageⅠ‒Ⅱ,body mass index(BMI)18.5‒28.0 kg/m^(2),were randomly divided into propofol full intravenous anesthesia group(intravenous group)and full sevoflurane inhalation anesthesia group(inhalation group)(n=30).Anesthesia induction:midazolam 0.04 mg/kg,fentanyl 6μg/kg,propofol 1.5‒2.0 mg/kg,cisatracurium benzene sulfonate 0.3 mg/kg were used in the intravenous group;etomidate 0.2 mg/kg was used in the inhalation group instead of propofol,and the other induction drugs were the same as the intravenous group.In the intravenous group,propofol was infused continuously in targetcontrolled infusion(TCI)mode to maintain anesthesia,and the target concentration was 3‒4 mg/L;in the inhalation group,sevoflurane was inhaled continuously in 1.5%‒2.0%concentration,and bispectral index(BIS)index was maintained in 40‒60.On the day of operation(D0),the first day after operation(D1),and the third day after operation(D3),3 ml of peripheral venous blood was collected from the two groups.The absolute and relative counts of CD4^(+)CD25^(+)Foxp3^(+)regulatory T lymphocytes in peripheral blood were measured by flow cytometry.The cytokines IL17A,IFNγ,IL6 and IL10 concentration were measured by flow cytometry.Results Compared with the level of D0,the absolute and relative counts of CD4^(+)CD25^(+)Foxp3^(+)regulatory T lymphocytes in the peripheral blood of the two groups were decreased at D1,whereas the concentrations of IL17A and IL6 were increased(P<0.05),compared with D3,the level in the two groups almost basically recovered to D0.The concentration of IL17A and IL6 in the intravenous group was lower at D1 than that in the inhalation group(P<0.05)while there was no significant difference among the other indexes at the same time point.Conclusions Full propofol intravenous anesthesia and full sevoflurane inhalation anesthesia have no significant effect on the content of CD4^(+)CD25^(+)Foxp3^(+)regulatory T cells in the peripheral blood of patients with modified radical mastectomy.Compared with full inhalation anesthesia,full intravenous anesthesia can inhibit the overexpression of IL17A and IL6,which may be beneficial to preventing perioperative inflammation and immune protection of patients with breast cancer.