快速康复外科增强肺癌患者术后免疫功能

Application of enhanced recovery of surgery can enhance the immune function in patients undergoing lung cancer resection

目的:探讨胸外科应用快速康复外科增强肺癌患者术后免疫功能的作用及其机制。方法:选取2021年3月至2021年5月期间苏州大学附属第一医院和苏州大学附属第二医院胸外科收治的肺癌患者115例,随机分为对照组61例、快速康复外科(ERAS)组54例,对照组采取常规围手术期管理模式,ERAS组采取加速康复外科围手术期管理模式。记录两组患者手术后并发症发生情况及住院时长;流式细胞术检测患者外周血CD4+/CD8+T细胞亚群比例;酶联免疫吸附实验(ELISA)检测患者外周血C反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)表达水平;外周血(PBMCs)磁珠分离CD8+T细胞,ELISA检测CD8+T细胞释放γ-干扰素(IFN-γ)、穿孔素(perforin)水平。组间数据比较采用t检验。结果:ERAS组术后并发症发生率(4/54)显著低于对照组(22/61),差异有统计学意义(χ^(2)=4.173,P<0.05);ERAS组术后住院时长[(5.85±0.81)d]显著短于对照组[(8.15±0.96)d],差异有统计学意义(t=-2.181,P<0.05);ERAS组术后第7天时CRP值[(26.73±12.90)mg/L]显著低于对照组[(18.80±12.71)mg/L],差异有统计学意义(t=3.318,P<0.01);ERAS组术后第7天时PCT值[(0.08±0.06)ng/ml]显著低于对照组[(0.12±0.08)ng/ml],差异有统计学意义(t=2.355,P<0.05);ERAS组术后第7天时IL-6值[(24.98±12.57)pg/ml]显著低于对照组[(33.61±12.92)pg/ml],差异有统计学意义(t=3.620,P<0.01);ERAS组术后第7天时CD4+/CD8+T细胞亚群(1.65±0.41)高于对照组(1.40±0.32),差异有统计学意义(t=-2.773,P<0.05);ERAS组术后第7天时CD8+T细胞释放IFN-γ[(5.57±2.14)μg/L]显著高于对照组比[(4.51±2.23)μg/L],差异有统计学意义(t=2.106,P<0.05);ERAS组术后第7天时CD8+T细胞释放perforin[(417.63±136.13)ng/L]显著高于对照组[(351.67±118.58)ng/L],差异有统计学意义(t=1.228,P<0.05)。结论:胸外科ERAS临床治疗有效,可以通过影响肺癌患者CD8+T细胞分化和效应能力增强免疫功能。

Objective To investigate the effect and mechanism of enhanced recovery of surgery(ERAS)on immune function in postoperative patients undergoing VATS lung cancer resection.Methods A total of 115 cases of patients undergoing VATS lung cancer resection in the First and the Second Affiliated Hospital of Soochow University from March to May in 2021 were included and divided to ERAS group(61 cases)and control group(54)by random.The patients in ERAS group accepted ERAS treatment mode,and those in control group accepted regulator treatment mode.The ratio of CD4/CD8 was calculated at different time points based on T cell subgroup quantization in peripheral blood mononuclear cells(PBMCs).The concentrations of C reactive protein(CRP),procalcitonin(PCT)and interlekin-6(IL-6)were evaluated in PBMCs.The production of interferon-γ(IFN-γ)and perforin from CD8+T cells was evaluated.Furthermore,the complications and the length of postoperative hospital stay in patients were also recorded.Results Compared with the control group,the incidence of postoperative complications in ERAS group was significantly reduced(χ^(2)=4.173,P<0.05).The length of postoperative hospital stay in ERAS group wass significantly shorter(t=-2.181,P<0.05).The level of CRP was significantly lower in postoperative ERAS group at day 7(t=3.318,P<0.01).The PCT was significantly lower in postoperative ERAS group at day 7(t=2.355,P<0.05).The IL-6 was significantly lower in postoperative ERAS group at day 7(t=3.620,P<0.01).The CD4/CD8 ratio was significantly higher in postoperative ERAS group at day 7(t=-2.773,P<0.05).The secretion ability of IFN-γand perforin was significantly higher in postoperative ERAS group at day 7,respectively(t=2.106,1.228,P<0.05).Conclusion The application of ERAS can enhance the immune function in postoperative patients undergoing VATS lung cancer resection via the regulation of T cell differentiation and toxic function.