短疗程糖皮质激素对原发性胃癌病人术后并发症及炎性细胞因子的影响  

Effect of short-course glucocorticoids on postoperative complications and inflammatory cytokines in in patients with primary gastric cancer

作　　者：袁野[1] 曹钧 蔡逊[1] YUAN Ye;CAO Jun;Cai Xun(Department of General Surgery,Wuhan General Hospital of Chinese PLA,Wuhan 430064China)

机构地区：[1]中国人民解放军武汉总医院普通外科,430064

出　　处：《临床外科杂志》2018年第11期852-854,共3页Journal of Clinical Surgery

摘　　要：目的分析短疗程糖皮质激素对原发性胃癌病人术后并发症及炎症细胞因子的影响。方法因胃癌行腹腔镜辅助下胃部分切除术病人96例,随机分为对照组和治疗组。对照组术前术后采用常规治疗方案,治疗组在常规治疗的基础上加用静滴糖皮质激素(甲泼尼龙)每天1mg/kg,连用3天,后减半量使用2天后停药。比较两组病人术后并发症及住院情况,术前及术后1天、3天、7天血清白细胞介素(IL-6)、肿瘤坏死因子(TNF-α)、超敏C反应蛋白(hs-CRP)含量变化。结果对照组和治疗组术后胃排空障碍发生率分别为12. 5%和2. 1%、肠梗阻分别为14. 6%和2. 1%、吻合口漏分别为8. 3%和0,住院时间分别为(15. 52±3. 00)天和(13. 27±1. 54)天;术后第1天血清中IL-6分别为(109. 40±14. 48) pg/ml和(81. 59±12. 61) pg/ml,TNF-α分别为(52. 92±11. 67) pg/ml和(39. 16±11. 67) pg/ml,hs-CRP分别为(29. 56±4. 12) mg/ml和(22. 27±4. 61) mg/ml;第3天血清中IL-6分别为(93. 34±14. 19) pg/ml和(70. 19±12. 00) pg/ml,TNF-α分别为(44. 95±1. 55) pg/ml和(29. 99±1. 29) pg/ml,hs-CRP分别为(25. 58±1. 04) mg/ml和(18. 11±0. 47) mg/ml;第7天血清中IL-6分别为(83. 52±13. 99) pg/ml和(55. 74±11. 80) pg/ml,TNF-α分别为(34. 65±5. 44) pg/ml和(21. 85±4. 15) pg/ml,hs-CRP分别为(21. 11±3. 84) mg/ml和(14. 81±3. 38) mg/ml,两组比较差异均有统计学意义(P <0. 05)。结论原发性胃癌病人术后给予短疗程糖皮质激素可缩短住院时间,减少手术相关并发症,其机制可能与减少了血液中IL-6、TNF-α等炎症细胞因子以及C反应蛋白的表达有关。Objective To study the effect of short course glucocorticoid on postoperative complications and inflammatory cytokines in patients with primary gastric cancer. Methods A total of 96 patients who underwent laparoscopic partial gectomy for gastric cancer were concluded in this study. The patients were randomly divided into control group and treatment group,the patients of the control group received routine treatment in our department before and after the surgery,the treatment group were further treated with Glucocorticoid( methylprednisolone) intravenously based on the routine treatment,the dose of methylprednisolone were at 1 mg/kg weight/d for continual 3 days,followed by half the dose for another 2 days. The chi square test or t test were used as the methods for analysis of the data,including the postoperative complications and the time of hospitalization,the changes of serum levels of interleukin 6( IL-6),tumor necrosis factor alpha( TNF a) and hypersensitivity C reaction protein( hs-CRP) in 1 d,3 d and 7 d before and after the operation. Results Postoperative complications occurred in the two groups,including gastric emptying disorder( 12. 5% vs 2. 1%),intestinal obstruction( 14. 6% vs 2. 1%),anastomotic fistula( 8. 3% ratio 0) and hospitalization time [( 15. 52 ± 3. 00) d vs( 13. 27 ± 1. 54) d]. The serum levels of IL-6 [( 109. 40 ± 14. 48) pg/ml vs( 81. 59 ± 12. 61) pg/ml],TNF alpha( TNF-α) [( 52. 92 ± 11. 67) pg/ml vs( 39. 16 ± 11. 67) pg/ml],hs-CRP [( 29. 56 ± 4. 12) mg/ml vs( 22. 27 ± 4. 61) mg/ml]all had statistically significant at the first day( P < 0. 05). The serum levels of IL-6 [( 93. 34 ± 14. 19) pg/ml vs( 70. 19± 12. 00) pg/ml) ],TNF-α [( 44. 95 ± 1. 55) pg/ml vs( 29. 99 ± 1. 29) pg/ml]and hs-CRP [( 25. 58 ±1. 04) mg/ml vs( 18. 11 ± 0. 47) mg/ml] all had statistically significant at the third day( P < 0. 05). The serum levels of IL-6 [( 83. 52 ± 13. 99) pg/ml vs( 55. 74 ± 11. 80) pg/ml],TNF-α [( 34. 65 ± 5. 44) pg/ml vs( 21. 85 ± 4. 15) pg/ml],hs-CRP[( 21. 11 ± 3. 84) mg/ml

关 键 词：胃癌 外科手术 糖皮质激素 细胞因子 

分 类 号：R735.2[医药卫生—肿瘤]