白细胞介素-17和叉头状螺旋转录因子3在子痫前期发病机制中的作用及剖宫产术后自控镇痛对其表达的影响  

The role of IL-17 and Foxp3 in the pathogenesis of preeclampsia and the effect of patient-controlled analgesia after cesarean section on their expression

作　　者：杨芬[1] 魏磊[1] 吴一帆[1] 王幸双[1] 闫芳[1] 钱利军[1] 赵李红[1] 宋晔[1] 谢阳[1] 苏惠斌[1] YANG Fen;WEI Lei;WU Yifan;WANG Xingshuang;YAN Fang;QIAN Lijun;ZHAO Lihong;SONG Ye;XIE Yang;SU Huibin(Department of Anesthesia,Suzhou Municipal Hospital,Suzhou,Jiangsu 215002,China)

机构地区：[1]苏州市立医院本部麻醉科,江苏苏州215002

出　　处：《安徽医药》2021年第9期1770-1774,共5页Anhui Medical and Pharmaceutical Journal

基　　金：苏州市科教兴卫--青年科技项目(KJXW2017026,KJXW2014019)。

摘　　要：目的探究白细胞介素-17(IL-17)和叉头状螺旋转录因子3(Foxp3)在子痫前期发病机制中的作用,对比重度子痫前期产妇剖宫产术后,超声引导下双侧腹横肌平面(TAP)阻滞复合静脉泵自控镇痛(PCIA)与硬膜外镇痛对疼痛控制及外周血中IL-17和Foxp3表达水平的影响。方法筛选2016年2月至2020年2月苏州市立医院重度子痫前期产妇40例,按随机数字表法分为两组(n=20),于腰-硬联合阻滞麻醉(CSEA)下行剖宫产手术,术毕T组:超声引导下低位TAP阻滞,双侧各注入0.375%罗哌卡因20 mL,复合舒芬太尼50μg+氟比洛芬200 mg生理盐水稀释至100 mL静脉自控镇痛;E组:0.15%罗哌卡因100 mL+0.04 mg/L舒芬太尼,硬膜外泵镇痛。另选20例正常产妇入C组为对照组。术后6 h(T_(1))、12 h(T_(2))、24 h(T_(3))、48 h(T_(4))对T组和E组产妇进行视觉模拟评分法(VAS)。酶联免疫吸附测定(ELISA)检测外周血中IL-17和Foxp3表达水平,T组和E组产妇于麻醉开始即刻T_(0)、T_(1)、T_(2)、T_(3)、T_(4);C组于入院分娩时(T)。结果T组和E组产妇静止、咳嗽VAS评分差异无统计学意义(P>0.05);T组和E组T_(0)时较C组IL-17水平明显升高、Foxp3水平明显降低;T组和E组,T_(1)较T_(0) IL-17水平明显升高、Foxp3水平明显降低,T_(3)、T_(4)较T_(1) IL-17水平逐渐减低、Foxp3水平逐渐升高,T_(3)较T_(2),T_(4)较T_(0)、T_(2)、T_(3) IL-17水平明显降低、Foxp3水平明显升高(P<0.05);T_(1)和T_(2),T组和E组间IL-17、Foxp3水平变化差异无统计学意义(P>0.05);T_(3)和T_(4),较T组,E组IL-17水平[(68.98±14.82)ng/L比(83.51±15.77)ng/L,(36.38±12.34)ng/L比(51.65±18.43)ng/L]明显降低,Foxp3水平[(89.36±25.83)ng/L比(74.97±23.31)ng/L,(116.17±32.46)ng/L比(98.74±27.59)ng/L]明显升高(P<0.05)。结论Foxp3低表达和IL-17高表达参与了子痫前期的发病过程,可能与发病机制相关。超声引导下双侧TAP阻滞复合PCIA对剖宫产术后镇痛效果确切,有效调控IL-17和Foxp3表达,促进术�Objective To explore the role of IL-17 and Foxp3 in the pathogenesis of preeclampsia,and to compare the effects of ultrasound-guided bilateral TAP block combined with PCIA and epidural analgesia on pain control and IL-17 and Foxp3 expression levels in peripheral blood of severe preeclampsia patients after cesarean section.Methods Forty patients with severe preeclampsiain Suzhou Municipal Hospital from February 2016 to February 2020 were selected and randomly divided into two groups according to random number table method(n=20).Patients were treated with combined spinal-epidural anesthesia and postoperative analgesia.T group:patients underwent ultrasound guided TAP block,bilateral injection of 0.375%ropivacaine 20 mL,combined with sufentanil 50μg+flurbiprofen 200 mg and normal saline to 100 mL PCIA;E group:patients underwent controlled epidural analgesia with 0.15%ropivacaine 100 mL+0.04 mg/L sufentanil.Another 20 normal pregnant women were selected as control group.Visual analogue scale(VAS)scores were recorded at 6,12,24,48 h post-operation.By the ELISA method,IL-17 and Foxp3 expression levels were detected in maternal peripheral blood in group T and group E when anesthesia began immediately and at 6,12,24,48 h post-operation,and in group C when the parturient was admitted to hospital and delivered.Results There was no significant difference in VAS score between group T and group E(P>0.05).In group T and group E,when anesthesia began immediately,the level of IL-17 was significantly higher and the level of Foxp3 was significantly lower than that in group C.In group T and group E,the level of IL-17 was significantly higher and the level of Foxp3 was significantly lower at 6 h post-operation than those when anesthesia began immediately.The level of IL-17 decreased gradually and the level of Foxp3 increased gradually at 24,48 h post-operation compared with 6 h post-operation.The level of IL-17 was significantly lower and the level of Foxp3 was significantly higher at 24 h post-operation than those at 12 h post-oper

关 键 词：先兆子痫 腹横肌平面阻滞 硬膜外镇痛 剖宫产术 白细胞介素-17 叉头状螺旋转录因子3 

分 类 号：R614[医药卫生—麻醉学]