氟比洛芬酯对食管癌患者围术期外周血树突状细胞亚群数量的影响

摘要

目的：观察氟比洛芬酯对食管癌患者围术期外周血中天然树突状细胞（ dendritic cells，DCs）亚群数量的影响。方法纳入健康志愿者20例和拟行开胸食管中段癌根治切除术患者40例（对照组20例、干预组20例）。干预组术前（切皮前30 min）给予氟比洛芬酯（2 mg· kg－1），术毕（缝皮前30 min）给予氟比洛芬酯（2 mg· kg－1），对照组术前、术毕给予脂肪乳。两组患者术后均使用舒芬太尼＋昂丹司琼行自控静脉镇痛（ patient－controlled intravenous analgesia， PCIA）。流式细胞术检测术前、术毕24、48 h外周血中髓样DC（ myeloid－DCs， mDCs）和浆细胞样DC（ plasmacytoid－DCs， pDCs）两个主要亚群在外周血单个核细胞（ peripheral blood mononuclear cells， PBMCs）中所占比例及其变化。记录术后48 h内的视觉模拟评分（ visual analogue scale， VAS）和舒芬太尼消耗量。结果与健康志愿者相比，食管癌患者外周血mDCs和pDCs亚群在PBMCs中所占比例均显著降低。与对照组相比，干预组患者使用氟比洛芬酯后，术毕24 h外周血中mDCs和pDCs亚群数量显著升高；术毕48 h对照组和干预组患者外周血中mDCs、pDCs亚群数量无显著差异。术毕12、24、36、48 h的对照组和干预组患者VAS评分无显著差异；与对照组相比，干预组患者术毕48 h消耗的舒芬太尼显著减少。结论使用氟比洛芬酯进行围术期镇痛时可以一定时间内上调食管癌患者外周血中DCs亚群水平。%Objective To investigate whether flurbiprofen axetil ( FA) modulates the naturally circulating dendritic cells ( DCs) sub-setsinpatientswithesophagealcarcinomaundergoingthoracicsurgery.Methods 20healthysubjectswereenraued40patientsun-dergoing esophageal radical resection for carcinoma were randomly assigned into two groups, group C ( control group, n=20 ) and group F (intervention group, n=20).FA (2 mg· kg-1) was administered i.v.30 min before skin incision and at the end of surgery in group F while placebo was adopted in group C.Both groups received postoperative ( post-OP) patient-controlled intravenous anal-gesia ( PCIA) using sufentanil.The percentages of plasmacytoid ( p) DCs and myeloid( m) DCs subtypes among peripheral blood mono-nuclear cells ( PBMCs) were measured by flow cytometry ( FCM) .Furthermore, visual analogue scale ( VAS) scores, sufentanil con-sumption during post-OP 48 h were recorded.Results FCM results showed that percentages of pDCs and mDCs in patients preoper-atively ( pre-OP) were significantly lower compared to those in healthy donors.In comparison with group C, treatment with FA signif-icantly up-regulated the depressed percentages of pDCs and mDCs in patients after surgery ( post-OP 24 h) .It also provided a simi-lar analgesic effect on patients according to VAS score, and brought a significantly less sufentanil consumption during post-OP 48 h. Conclusion Peri-operative treatment with FA alleviated the surgery-induced suppressed circulating pDCs, and mDCs percentages in patients with esophageal carcinoma undergoing esophageal radical resection.