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  

Effects of Different Anesthesia Methods on T lymphocyte Subsets and Th cell Differentiation in Patients Undergoing Thoracic and Lumbar Spinal Tuberculosis Surgery

作　　者：李良[1] 乐文随 朱立 吴激波[2] 方凤玲[1] 陈浩[1] 刘小政[3] 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)

机构地区：[1]湖北省十堰市西苑医院麻醉科,湖北十堰442004 [2]湖北省十堰市西苑医院感染科,湖北十堰442004 [3]湖北省十堰市西苑医院检验科,湖北十堰442004

出　　处：《湖北医药学院学报》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)

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 pe

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 

分 类 号：R614[医药卫生—麻醉学]