Effect of propofol on inhibiting the stress action for the perioperative patients with colorectal carcinoma: an immunological view from the CD4+CD25+ regulatory T cells

doi:10.3969/j.issn.1009-976X.2014.01.023

Abstract

Abstract: 【Abstract】〓Objective〓To explore the effect of propofol on inhibiting the stress action for the perioperative patients with colorectal carcinoma,basing on the immunological view from the CD4+CD25+ regulatory T cells (Treg). Methods〓Fifty perioperative patients with colorectal carcinoma were randomly divided into the observation and control group(n=25 for both). Target-controlled infusion (TCI) with propofol and remifentanil was given for the observation group,while the intravenous inhalation anesthesia with fentanil and isoflurane was given for the control group. The vital sign together the stress indexes were recorded at the three time points: before anesthesia induction (T1), 10 min after colon excision (T2) and after the whole operation (T3). The flow cytometry (FCM) was applied to test the levels of the Tregs, together with their intracellular cytokines including IL-10 and TGF-β1. Results〓1) Vital sign:the heart rate (HR) and mean arterial pressure (MAP) in the observation group were significantly lower than those in the control group at T2 and T3 (P<0.05). Stress indexes: the level of C-reaction protein (CRP), blood glucose (Glu) and interleukin 6 (IL-6) in the observation group were also significantly lower than those in the control group at T2 and T3 (P<0.05). 3) Immunological indexes: the levels of Tregs, IL-10 and TGF-β1 in the observation group were significantly higher than those in the control group at T2 and T3 (P<0.05). 4) Correlation analysis showed that anyone of Tregs, IL-10 and TGF-β1 negatively correlated with anyone of HR, MAP, CRP, Glu and IL-6(all |r|>0.65 and all P<0.05). Conclusion〓There is a relationship between Tregs and stress action for the perioperative patients with colorectal carcinoma. Propofol could regulate the activity of Tregs and its effect was better than fentanil.

Key words: Propofol, Regulatory T cells, Stress, Perioperative period

摘要：

【摘要】〓目的〓从T细胞亚群免疫角度评价丙泊酚降低围手术期结肠癌患者应激的作用。方法〓将50例围手术期结肠癌患者随机分为观察组与对照组各25例,观察组采用靶控输注丙泊酚复合瑞芬太尼持续泵注,对照组给予芬太尼-异氟醚静吸复合麻醉。比较麻醉诱导前(T1)、摘除病变结肠后10分钟(T2)及术后24 h(T3)共3个时相点的生命征和应激指标差异;ELISA法测定外周血白介素-6(IL-6)水平;采用流式细胞术检测两组患者上述三个时相外周血CD4+CD25+调节性T细胞(Treg)及其胞内细胞因子IL-10及转化生长因子-β1(TGF-β1)的水平。结果〓1)生命征:T2及T3时相观察组患者心率(HR)及平均动脉压(MAP)均显著低于对照组。2)应激指标:T2及T3观察组患者C-反应蛋白(CRP)、血糖(Glu)及白介素-6(IL-6)均显著低于对照组(P<0.05)。3)免疫指标:与对照组比较,观察组T2及T3时相的Treg、IL-10及TGF-β1水平均明显高于对照组(P<0.05)。4)相关性分析显示Treg、IL-10及TGF-β1三者的水平均与HR、MAP、CRP、Glu及IL-6任意一者成显著负相关性(r绝对值>0.65,P<0.05)。结论〓CD4+CD25+调节性T细胞(Treg)与结肠癌患者的围手术期应激有密切关系,丙泊酚可能通过改善Treg的活性从而发挥抗应激的效果,且其效价优于芬太尼。

关键词: 丙泊酚, 调节性T细胞, 应激, 围手术期

CLC Number:

R656.9

Wu Qisheng, Lin Shiqing, Yang Kaihua. Effect of propofol on inhibiting the stress action for the perioperative patients with colorectal carcinoma: an immunological view from the CD4+CD25+ regulatory T cells[J]. Lingnan Modern Clinics in Surgery, 2014, 14(01): 79-82.

吴启胜林世清杨开花. 从调节性T细胞免疫角度评估丙泊酚降低围手术期结肠癌患者应激的作用[J]. 岭南现代临床外科, 2014, 14(01): 79-82.

References

　　　[1] Inada T, Kubo K, Ueshima H, et al.Intravenous anesthetic propofol suppresses prostaglandin E2 production in murine dendritic cells[J].J Immunotoxicol,2011,8(4):359-366.
　　　[2] Yuki K, Soriano SG, Shimaoka M.Sedative drug modulates T-cell and lymphocyte function-associated antigen-1 function[J].Anesth Analg,2011,112(4):830-838.
　　　[3] Sellitto A, Galizia G, De Fanis U,et al.Behavior of circulating CD4+CD25+Foxp3+ regulatory T cells in colon cancer patients undergoing surgery[J].J Clin Immunol, 2011,31(6):1095-1104.
　　　[4] Correale P, Rotundo MS, Del Vecchio MT,et al.Regulatory (FoxP3+) T-cell tumor infiltration is a favorable prognostic factor in advanced colon cancer patients undergoing chemo or chemoimmunotherapy[J].J Immunother, 2010,33(4):435-441.
　　　[5] 刘民强,李凤仙,刘中杰,等.不同麻醉方式用于老年患者腹腔镜乙状结肠原位新膀胱术的临床效果[J].临床麻醉学杂志,2011,27 (9):864-866.
　　　[6] 季蒙，陶军，王庆利，等. 靶控输注麻醉方式对腹腔镜胆囊切除术患者应激反应的影响[J]. 局解手术学杂志,2012,21(5):490-493.
　　　[7] 胡义凤,张利东,罗伟,等.七氟醚与丙泊酚麻醉对心内直视手术患者应激反应的影响[J]. 临床麻醉学杂志,2012,28(4):346-348.
　　　[8] 陈亚丽,谭敬,景桂霞.丙泊酚靶控输注联合脑电双频指数在高龄患者麻醉诱导期的应用[J].临床麻醉学杂志,2011,27(9):881-884.
　　　[9] Inada T, Kubo K, Shingu K.Promotion of interferon-gamma production by natural killer cells via suppression of murine peritoneal macrophage prostaglandin E2 production using intravenous anesthetic propofol[J].Int Immunopharmacol,2010,10(10):1200-1208.
　　　[10] 陈巧英,李大金.CD4+CD25+调节性T细胞的生物学特性及功能[J] .中国免疫学杂志,2007,(1) 89-92.
　　　[11] Ren XF, Li WZ, Meng FY,et al.Differential effects of propofol and isoflurane on the activation of T-helper cells in lung cancer patients[J].Anaesthesia,2010,65(5):478-482.
　　　[12] Roesslein M, Schibilsky D, Muller L, et al.Thiopental protects human T lymphocytes from apoptosis in vitro via the expression of heat shock protein 70[J].J Pharmacol Exp Ther,2008,325(1):217-225.
　　　[13] 刘柳,庞勇,何东伟,等.丙泊酚对离体大鼠缺血再灌注心脏PI3K／Akt信号通路及内质网应激凋亡途径的影响[J].中华医学杂志,2012,92(37):2611-2614.
　　　[14] 李云,张野,左友梅,等.右美托咪定对瑞芬太尼复合丙泊酚靶控输注全麻的影响[J].临床麻醉学杂志,2012,28(5):454-456.
　　　[15] Kushida A, Inada T, Shingu K.Enhancement of antitumor immunity after propofol treatment in mice[J].Immunopharmacol Immunotoxicol,2007,29(3-4):477-486.