摘要
目的:观察不同麻醉方法对胸腰段脊柱结核病灶清除术患者T淋巴细胞亚群和Th细胞分化的影响。方法:根据美国麻醉医师协会(ASA)Ⅰ~Ⅱ级60例择期行胸腰段脊柱结核病灶清除术患者,随机均分为3组:A组采用连续硬膜外麻醉、B组采用静脉复合全麻、C组采用连续硬膜外复合静脉全麻。流式细胞术检测麻醉前30 min(T0)、术后2 h(T1)、术后4 h(T2)、术后24 h(T3)时点的患者外周血CD4+T淋巴细胞、CD8+T淋巴细胞、CD3+CD8-IFN-γ+T淋巴细胞、CD3+CD8-IL-4+T淋巴细胞的百分比,计算CD4+/CD8+比值。用CD3+CD8-IFN-γ+T淋巴细胞、CD3+CD8-IL-4+T淋巴细胞分别代表Th1和Th2细胞,计算Th1/Th2比值。结果:与麻醉前比较,CD4+%、CD4+/CD8+比值A组T2、T3时点和B组T1~T3时点下降,差异有统计学意义(P<0.05),C组差异无统计学意义(P>0.05);组间比较C组T2、T3时点CD4+%、CD4+/CD8+比值明显高于A、B组(P<0.05)。Th1%各组T2、T3时点均较麻醉前下降,C组T2、T3时点较A、B组升高(P<0.05)。Th2%A、B组T2、T3时点及C组T3时点较麻醉前明显升高,T2时点C组与B组有差异(P<0.05)。Th1/Th2比值在T3时点与麻醉前相比各组均下降,C组高于A、B组,差异有统计学意义。结论:胸腰段脊柱结核病灶清除术患者术中、术后免疫功能受到抑制,连续硬膜外复合静脉全麻能减缓患者术中、术后外周血CD4+T淋巴细胞百分比和CD4+/CD8+比值的下降,并能减轻术后Th0细胞向Th2细胞的过度分化,减轻术中术后细胞免疫抑制的程度。
Objective To observe the effect of different anesthesia methods on T lymphocyte subsets and Th cell differentiation in patients with thoracolumbar spine tuberculosis. Methods According to the American Association of Anesthesiologists（ ASA）,60 patients（ class Ⅰ - Ⅱ）,with lumbar spine tuberculosis,were randomly divided into three groups： group A was treated with continuous epidural anesthesia; group B was treated with intravenous anesthesia; and group C was treated with continuous epidural anesthesia combined with intravenous anesthesia. Flow cytometry was used to detect the peripheral blood of patients 30 min before anesthesia（ T0）,2 h after operation（ T1）,4 h after operation（ T2） and 24 h after operation（ T3）. Detected lymphocytes include CD4＋T lymphocytes,CD8＋T lymphocytes,CD3＋CD8＋-IFN-γ＋T lymphocytes,CD3＋CD8-IL-4＋T lymphocytes,and CD4＋/CD8＋ratio calculation. CD3＋CD8＋-IFN-γ＋T lymphocytes and CD3＋CD8＋IL-4＋T lymphocytes were used to represent Th1 and Th2 cells respectively,thereby performing Th1/Th2 ratio calculation. Results Compared with pre-anesthesia,CD4＋%,and CD4＋/CD8＋ratio of group A（ at T2 and T3） and group B（ at T1- T3）significantly decreased（ P〈0.05）. There was no significant difference in Group C（ P〉0.05）. CD4＋% and CD4＋/CD8＋ratio at T2 and T3 in group C were significantly higher than those in groups A and B（ P 0.05）. At time points T2 and T3,the levels of Th1% in all groups were lower than those before anesthesia,but Th1% in group C was higher than those in groups A and B（ P〈0.05）. The levels of Th2% in groups A and B at T2 and T3,in group C at T3 were significantly higher than those before anesthesia. There were differences between group C and group B at T2（ P〈0.05）. The ratio of Th1/Th2 at T3 was lower than that before anesthesia in all groups,and it was higher in group C than in groups A and B. the difference was statistically significant. Conclusion During intraoperative and postoperative period of thoracolumbar spinal tuberculosis surgery,patient＇s immune function is suppressed. Continuous epidural anesthesia combined with intravenous anesthesia can reduce the percentage of CD4＋T lymphocyte and CD4＋/CD8＋ratio in peripheral blood and reduce the differentiation of Th0 cells into Th2 cells after operation. Therefore,the choice of continuous epidural anesthesia combined with intravenous anesthesia can reduce the degree of cellular immunosuppression during and after operation in patients with thoracic and lumbar spinal tuberculosis.
作者
李良
乐文随
朱立
吴激波
方凤玲
陈浩
刘小政
LI Liang;YUE Wen-sui;ZHU LiI;WU Ji-bo;FANG Feng-ling;CHEN Hao;LIU Xiao- zheng(Department of Anesthesiology;Department of Infectious Diseases;Department of Laboratory, Xiyuan Hospital, Shiyan, Hubei, China 442004)
出处
《湖北医药学院学报》
CAS
2017年第5期432-436,共5页
Journal of Hubei University of Medicine
基金
十堰市科学技术研究与开发项目计划(14Y68)
关键词
麻醉方法
硬膜外麻醉
脊柱结核
免疫功能
T淋巴细胞亚群
TH细胞分化
Anesthesia
Epidural anesthesia
Spinal tuberculosis
Immune function
T lymphocyte subsets
Th cell differentiation
