帕瑞昔布抑制乳腺癌改良根治术后中性粒细胞与淋巴细胞比值升高  

Parecoxib suppresses the increase of neutrophil-tolymphocyte ratio after the modified radical mastectomy

作　　者：李云丽[1] 周磊 李潇潇 陈功 段开明[1] 丁波泥[2] 欧阳文[1] LI Yunli ZHOU Lei LI Xiaoxiao CHEN Gong DUAN Kaiming DING Boni OUYANG Wen(Department of Anesthesiology Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha 410013, China)

机构地区：[1]中南大学湘雅三医院麻醉科,长沙410013 [2]中南大学湘雅三医院普外科,长沙410013

出　　处：《中南大学学报（医学版）》2017年第9期1048-1052,共5页Journal of Central South University ：Medical Science

基　　金：湖南省自然科学基金(2017JJ3429)~~

摘　　要：目的:通过观察环氧合酶(cyclooxygenase 2,COX-2)抑制药帕瑞昔布对乳腺癌改良根治术后患者外周血中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)的影响,探讨其抑制围手术期炎症反应的机制。方法:收集行乳腺癌改良根治术的患者入组,其中帕瑞昔布组20例,对照组20例。帕瑞昔布组患者于全麻诱导时、术后第1天和第2天各静脉注射帕瑞昔布40 mg(5 m L);对照组在相同的时间点静脉注射同等体积的生理盐水。两组患者分别于手术当天、术后第1天、术后第3天和术后第7天清晨抽取2 m L静脉血,立即送入实验室进行血常规检测。结果:与术前相比,对照组术后第1天和第3天的NLR均显著升高(P<0.05),术后第7天恢复至术前水平(P>0.05);帕瑞昔布组术后第1天的NLR显著升高(P<0.01),术后第3天恢复至术前水平(P>0.05)。组间比较显示:术后第1天帕瑞昔布组的NLR明显低于对照组(P<0.05),其余时间点差异无统计学意义(P>0.05)。结论:帕瑞昔布能通过抑制乳腺癌患者术后NLR升高发挥抗炎和免疫保护作用,有望改善乳腺癌患者的预后。Objective： To observe the effect of parecoxib on neutrophil-to-lymphocyte ratio （NLR）after the modified radical mastectomy, and to explore its potential mechanisms for inhibition ofperioperative inflammation. Methods： A total of 40 breast cancer patients undergone the modified radical mastectomy were randomly divided into a parecoxib group （n=20） and a control group （n=20）. The parecoxib group received intravenous parecoxib （40 mg, 5 mL） during general anesthesia induction, post-operative day 1 and day 2; the control group received intravenous normal saline （5 mL） at the corresponding time points. Their peripheral bloods were collected for routine test in the morning of the surgery day （T1）, and Day i （T2）, Day 3 （T3） and Day 7 （T4） after the surgery3 and NLRwas calculated. Results： Compared with T1, NLR in the control group at T2 and T3 was significantly increased （P〈0.05）, but not at T4 （P〉0.05）; NLR in the parecoxib group was sharply increased at T2 （P〈0.01）, and returned to preoperative levels at T3 and T4 （P〉0.05）. NLR in the parecoxib group was significantly lower than that in the control group at T2 （P〈0.05）, but there were no significant difference between the two groups at other time points （P〉0.05）. Conclusion： Parecoxib can restrain the inflammatory responses and improve immune function of the breast cancer patients by suppressing the elevation of NLR after the modified radical mastectomy, which is expected to improve the prognosis of the breast cancer patients.

关 键 词：乳腺癌 围手术期 帕瑞昔布 中性粒细胞与淋巴细胞比值 

分 类 号：R614[医药卫生—麻醉学] R737.9[医药卫生—外科学]