目的 探讨急性等容血液稀释(acute normovolemic hemodilution,ANH)联合低中心静脉压(low central venous pressure,LCVP)对肝癌患者调节性T细胞及自然杀伤(natural killer,NK)细胞的影响. 方法 同一手术医师实施择期右肝癌患者66例,采用随机数字表法将患者均分为3组(每组22例):ANH联合LCVP组(A+L组)、LCVP组(L组)和ANH组(A组).分别于麻醉前(T0)、术后第1天晨(T1)、术后第3天晨(T2)、术后第5天晨(T3)抽取外周静脉血测定调节性T细胞及NK细胞的情况. 结果 在所有患者中,与T0时比较:A+L组T2、T3时,CD4+CD25+[(9.0±1.4)、(8.3±1.3)]、CD25+FOXP3+[(3.6±0.7)、(3.3±0.7)]均降低,CD8+[(23.7±3.8)、(26.9±-2.8)] 、CD4+CD25[(36.7±3.1) 、(38.0±1.9)]均增加,T1时NK细胞(12.8±2.8)降低;L组和A组T1、T2时CD4+CD25+[(12.1±2.9)、(12.4±3.3)和(13.3±2.9)、(13.0±3.8)]、CD25+FOXP3+[(5.4±1.5)、(5.2±1.8)和(6.0±1.9)、(5.5±2.0)]均增加,T1时CD8+[(17.8±3.7)和(16.5±3.1)]降低,T1、T2、T3时NK细胞[(12.6±3.4)、(11.4±4.2)、(12.5±4.8)和(11.1±3.5)、(11.2±4.7)、(11.0±5.3)]均降低,A组T1、T2时CD4+CD25-[(30.3±3.8)、(31.2±6.5)]均降低,差异有统计学意义(P＜0.05).与A+L组比较,T1、T2、T3时L组和A组CD4+CD25+[(12.1±2.9)、(12.4±3.3)、(10.8±3.9)和(13.3±2.9)、(13.0±3.8)、(12.6±4.3)]、CD25+FOXP3+[(5.4±1.5)、(5.2±1.8)、(4.6±1.9)和(6.0±1.9)、(5.5±2.0)、(4.9±1.7)]均增加,A组CD8+[(16.5±3.1)、(18.6±6.3)、(19.2±6.9)]均降低;T2、T3时L组CD8+[(18.9±4.0)、(20.5±5.0)]、CD4+CD25-[(32.4±5.3)、(34.6±6.2)]降低,A组CD4+CD25[(31.2±6.5)、(31.8±6.8)]均降低,L组和A组NK细胞[(11.4±4.2)、(12.5±4.8)和(11.2±4.7)、(11.0±5.3)]均降低,差异有统计学意义(P＜0.05).在未输异体血患者中:与T0时比较,A+L组和A组于T2 、T3时CD4+CD25+[(9.0±1.4)、(8.3±1.3)和(9.4±1.8)、(8.5±1.3)]、CD25+FOXP3+[(3.6±0.7)、(3.4±0.7)和(3.7±0.8)、(3.4±0.8)]均减少,CD8+[(23.7±3.8)、(26.9±2.8)和(24.3±3.2) 、(25.61±3.0)] 、CD4+CD25[(36.7±3.1)、(38.0-±1.9)和(37.3±2.5)、(38.2±2.4)]增加,T1时NK细胞[(12.8±2.8)和(13.4±3.6)]减少;L组于T3时CD4+CD25+(8.6± 1.4)、CD25+FOXP3+(3.7± 1.0)减少,CD8+(23.3±2.5)、CD4+CD25(38.1±2.3)增加,T1、T2时NK细胞[(13.8±3.2)、(13.2±3.5)]均减少,差异有统计学意义(P＜0.05).与A+L组比较,L组T2时CD4+CD25+(10.9±2.5) 、CD25+FOXP3+(4.3±1.0)均增加,NK细胞(13.2±3.5)减少,T2 、T3时CD8+ (20.7±3.0)、(23.3±2.5)均减少,差异有统计学意义(P＜0.05);A组各时点差异均无统计学意义(P＞0.05). 结论 在肝癌手术中联合应用ANH和LCVP技术,可以较快的改善患者术后的免疫功能和NK细胞的免疫调节功能.
目的 探討急性等容血液稀釋(acute normovolemic hemodilution,ANH)聯閤低中心靜脈壓(low central venous pressure,LCVP)對肝癌患者調節性T細胞及自然殺傷(natural killer,NK)細胞的影響. 方法 同一手術醫師實施擇期右肝癌患者66例,採用隨機數字錶法將患者均分為3組(每組22例):ANH聯閤LCVP組(A+L組)、LCVP組(L組)和ANH組(A組).分彆于痳醉前(T0)、術後第1天晨(T1)、術後第3天晨(T2)、術後第5天晨(T3)抽取外週靜脈血測定調節性T細胞及NK細胞的情況. 結果 在所有患者中,與T0時比較:A+L組T2、T3時,CD4+CD25+[(9.0±1.4)、(8.3±1.3)]、CD25+FOXP3+[(3.6±0.7)、(3.3±0.7)]均降低,CD8+[(23.7±3.8)、(26.9±-2.8)] 、CD4+CD25[(36.7±3.1) 、(38.0±1.9)]均增加,T1時NK細胞(12.8±2.8)降低;L組和A組T1、T2時CD4+CD25+[(12.1±2.9)、(12.4±3.3)和(13.3±2.9)、(13.0±3.8)]、CD25+FOXP3+[(5.4±1.5)、(5.2±1.8)和(6.0±1.9)、(5.5±2.0)]均增加,T1時CD8+[(17.8±3.7)和(16.5±3.1)]降低,T1、T2、T3時NK細胞[(12.6±3.4)、(11.4±4.2)、(12.5±4.8)和(11.1±3.5)、(11.2±4.7)、(11.0±5.3)]均降低,A組T1、T2時CD4+CD25-[(30.3±3.8)、(31.2±6.5)]均降低,差異有統計學意義(P＜0.05).與A+L組比較,T1、T2、T3時L組和A組CD4+CD25+[(12.1±2.9)、(12.4±3.3)、(10.8±3.9)和(13.3±2.9)、(13.0±3.8)、(12.6±4.3)]、CD25+FOXP3+[(5.4±1.5)、(5.2±1.8)、(4.6±1.9)和(6.0±1.9)、(5.5±2.0)、(4.9±1.7)]均增加,A組CD8+[(16.5±3.1)、(18.6±6.3)、(19.2±6.9)]均降低;T2、T3時L組CD8+[(18.9±4.0)、(20.5±5.0)]、CD4+CD25-[(32.4±5.3)、(34.6±6.2)]降低,A組CD4+CD25[(31.2±6.5)、(31.8±6.8)]均降低,L組和A組NK細胞[(11.4±4.2)、(12.5±4.8)和(11.2±4.7)、(11.0±5.3)]均降低,差異有統計學意義(P＜0.05).在未輸異體血患者中:與T0時比較,A+L組和A組于T2 、T3時CD4+CD25+[(9.0±1.4)、(8.3±1.3)和(9.4±1.8)、(8.5±1.3)]、CD25+FOXP3+[(3.6±0.7)、(3.4±0.7)和(3.7±0.8)、(3.4±0.8)]均減少,CD8+[(23.7±3.8)、(26.9±2.8)和(24.3±3.2) 、(25.61±3.0)] 、CD4+CD25[(36.7±3.1)、(38.0-±1.9)和(37.3±2.5)、(38.2±2.4)]增加,T1時NK細胞[(12.8±2.8)和(13.4±3.6)]減少;L組于T3時CD4+CD25+(8.6± 1.4)、CD25+FOXP3+(3.7± 1.0)減少,CD8+(23.3±2.5)、CD4+CD25(38.1±2.3)增加,T1、T2時NK細胞[(13.8±3.2)、(13.2±3.5)]均減少,差異有統計學意義(P＜0.05).與A+L組比較,L組T2時CD4+CD25+(10.9±2.5) 、CD25+FOXP3+(4.3±1.0)均增加,NK細胞(13.2±3.5)減少,T2 、T3時CD8+ (20.7±3.0)、(23.3±2.5)均減少,差異有統計學意義(P＜0.05);A組各時點差異均無統計學意義(P＞0.05). 結論 在肝癌手術中聯閤應用ANH和LCVP技術,可以較快的改善患者術後的免疫功能和NK細胞的免疫調節功能.
목적 탐토급성등용혈액희석(acute normovolemic hemodilution,ANH)연합저중심정맥압(low central venous pressure,LCVP)대간암환자조절성T세포급자연살상(natural killer,NK)세포적영향. 방법 동일수술의사실시택기우간암환자66례,채용수궤수자표법장환자균분위3조(매조22례):ANH연합LCVP조(A+L조)、LCVP조(L조)화ANH조(A조).분별우마취전(T0)、술후제1천신(T1)、술후제3천신(T2)、술후제5천신(T3)추취외주정맥혈측정조절성T세포급NK세포적정황. 결과 재소유환자중,여T0시비교:A+L조T2、T3시,CD4+CD25+[(9.0±1.4)、(8.3±1.3)]、CD25+FOXP3+[(3.6±0.7)、(3.3±0.7)]균강저,CD8+[(23.7±3.8)、(26.9±-2.8)] 、CD4+CD25[(36.7±3.1) 、(38.0±1.9)]균증가,T1시NK세포(12.8±2.8)강저;L조화A조T1、T2시CD4+CD25+[(12.1±2.9)、(12.4±3.3)화(13.3±2.9)、(13.0±3.8)]、CD25+FOXP3+[(5.4±1.5)、(5.2±1.8)화(6.0±1.9)、(5.5±2.0)]균증가,T1시CD8+[(17.8±3.7)화(16.5±3.1)]강저,T1、T2、T3시NK세포[(12.6±3.4)、(11.4±4.2)、(12.5±4.8)화(11.1±3.5)、(11.2±4.7)、(11.0±5.3)]균강저,A조T1、T2시CD4+CD25-[(30.3±3.8)、(31.2±6.5)]균강저,차이유통계학의의(P＜0.05).여A+L조비교,T1、T2、T3시L조화A조CD4+CD25+[(12.1±2.9)、(12.4±3.3)、(10.8±3.9)화(13.3±2.9)、(13.0±3.8)、(12.6±4.3)]、CD25+FOXP3+[(5.4±1.5)、(5.2±1.8)、(4.6±1.9)화(6.0±1.9)、(5.5±2.0)、(4.9±1.7)]균증가,A조CD8+[(16.5±3.1)、(18.6±6.3)、(19.2±6.9)]균강저;T2、T3시L조CD8+[(18.9±4.0)、(20.5±5.0)]、CD4+CD25-[(32.4±5.3)、(34.6±6.2)]강저,A조CD4+CD25[(31.2±6.5)、(31.8±6.8)]균강저,L조화A조NK세포[(11.4±4.2)、(12.5±4.8)화(11.2±4.7)、(11.0±5.3)]균강저,차이유통계학의의(P＜0.05).재미수이체혈환자중:여T0시비교,A+L조화A조우T2 、T3시CD4+CD25+[(9.0±1.4)、(8.3±1.3)화(9.4±1.8)、(8.5±1.3)]、CD25+FOXP3+[(3.6±0.7)、(3.4±0.7)화(3.7±0.8)、(3.4±0.8)]균감소,CD8+[(23.7±3.8)、(26.9±2.8)화(24.3±3.2) 、(25.61±3.0)] 、CD4+CD25[(36.7±3.1)、(38.0-±1.9)화(37.3±2.5)、(38.2±2.4)]증가,T1시NK세포[(12.8±2.8)화(13.4±3.6)]감소;L조우T3시CD4+CD25+(8.6± 1.4)、CD25+FOXP3+(3.7± 1.0)감소,CD8+(23.3±2.5)、CD4+CD25(38.1±2.3)증가,T1、T2시NK세포[(13.8±3.2)、(13.2±3.5)]균감소,차이유통계학의의(P＜0.05).여A+L조비교,L조T2시CD4+CD25+(10.9±2.5) 、CD25+FOXP3+(4.3±1.0)균증가,NK세포(13.2±3.5)감소,T2 、T3시CD8+ (20.7±3.0)、(23.3±2.5)균감소,차이유통계학의의(P＜0.05);A조각시점차이균무통계학의의(P＞0.05). 결론 재간암수술중연합응용ANH화LCVP기술,가이교쾌적개선환자술후적면역공능화NK세포적면역조절공능.
Objective To observe the effect of acute normovolemic hemodilution (ANH) combine with low central venous pressure (LCVP) on regulatory T cells and natural killer (NK) cells in patients undergoing liver cancer resection.Methods The Sixty-six patients undergoing right liver cancer operation operated by the same surgeon were equally randomized into three groups ANH,LCVP,or ANH+LCVP,respectively.Peripheral venous blood was extracted on postoperative days 0(T0),1(T1),3(T2),5(T3) to determine immune function including regulatory T cells and NK cells.Results Compare with T0,the levels of CD4+CD25+[(9.0±1.4),(8.3±1.3)] and CD25+FOXP3+[(3.6±0.7),(3.3±0.7)] decreased,CD8+[(23.7±3.8),(26.9±2.8)] and CD4+CD25[(36.7±3.1),(38.0±1.9)] increased at T2 and T3,NK cells (12.8±2.8) decreased at T1 in the A+L group; the levels of CD4+CD25+[(12.1±2.9),(12.4±3.3) and (13.3±2.9),(13.0±3.8)] and CD25+FOXP3+[(5.4±1.5),(5.2±1.8) and (6.0±1.9),(5.5±2.0)] increased,CD8+ [(17.8±3.7) and (16.5±3.1)] decreased at T1,NK cells [(12.6±3.4),(11.4±4.2),(12.5±4.8) and (11.1±3.5),(11.2±4.7),(11.0±5.3)]decreased at T1,T2 and T3 in the L and A groups,in addition,CD4+CD25[(30.3±3.8),(31.2±6.5)] decreased at T1 and T2 in the A group (P＜0.05).Compare with the A+L group,the levels of C D4+CD25+[(12.1 ±2.9),(12.4±3.3),(10.8±3.9) and (13.3±2.9),(13.0±3.8),(12.6±4.3)] and CD25+FOXP3+ [(5.4± 1.5),(5.2± 1.8),(4.6± 1.9) and (6.0± 1.9),(5.5±2.0),(4.9± 1.7)] increased in the L and A groups,CD8+ [(16.5±3.1),(18.6±6.3),(19.2±6.9)] decreased in the A group at T1,T2 and T3,the levels of CD8+[(18.9±4.0),(20.5±5.0)] and CD4+CD25[(32.4±5.3),(34.6±6.2)] decreased in the L group,CD4+CD25[(31.2±6.5),(31.8±6.8)] decreased in the A group,NK cells [(11.4±4.2),(12.5±4.8) and (11.2±4.7),(11.0±5.3)] decreased in the L and A groups at T2 and T3(P＜0.05).In the patients of non-allogeneic transfusion:compare with T0,the levels of C D4+CD25+ [(9.0± 1.4),(8.3± 1.3) and (9.4± 1.8),(8.5±1.3)] and CD25+FOXP3+[(3.6±0.7),(3.4±0.7) and (3.7±0.8),(3.4±0.8)] decreased,CD8+[(23.7±3.8),(26.9±2.8) and (24.3±3.2),(25.61 ±3.0)] and CD4+CD25[(36.7±3.1),(38.0± 1.9) and (37.3 ±2.5),(38.2±2.4)] increased at T2 and T3,NK cells [(12.8±2.8) and(13.4±3.6)] decreased at T1 in the A+L group and A groups,the levels of CD4+CD25+(8.6±1.4) and CD25+FOXP3+ (3.7± 1.0) decreased,CD8+(23.3±2.5) and CD4+CD25(38.1±2.3) increased at T3,NK cells(13.8±3.2),(13.2±3.5)] decreased at T1 and T2 in the L group (P＜0.05).Compare with the A+L group,the levels of CD4+CD25+(10.9±2.5) and CD25+FOXP3+(4.3±1.0)increased,NK cells (13.2±3.5) decreased at T2,CD8+ [(20.7±3.0),(23.3±2.5)] decreased at T2 and T3 in the L group (P＜0.05).However,the alterations of T lymphocyte subsets and NK cells in the A group were not significant difference at each time points(P＞0.05).Conclusions In liver cancer operations,ANH combine with LCVP can rapidly improve postoperative immune functions and NK cells immune regulatory functions.
