Effects of preoperative infusion of hydroxyethyl starch on T cell subsets and inflammatory factors in patients undergoing radical gastric cancer surgery
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摘要: 目的 探讨胃癌根治术患者术前输注羟乙基淀粉对T细胞亚群和炎症因子的影响。方法 选择延安大学附属医院2020年5月—2021年5月期间收治的胃癌根治术患者作为研究对象，共计90例，采用随机数字表法进行分组，分为A、B、C 3组，每组30例，3组患者均接受胃癌根治术，在术前，A组患者给予复方氯化钠注射液，B组患者给予聚明胶肽注射液，C组患者给予羟乙基淀粉注射液，分别于术前、术后1 d、术后3 d、术后7 d取患者肘静脉血进行相关指标的测定，具体包括T淋巴细胞亚群CD3+、CD4+、CD8+和炎症指标因子IL-2、IL-6、TNF-α。结果 术前，3组患者T细胞亚群以及炎症因子比较，差异无统计学意义(P>0.05)。3组患者术后1、3 d CD3+、CD4+水平显著低于手术前(P< 0.05)；术后1 d，B组CD4+水平较A组显著下降(P< 0.05)，术后3 d，C组、B组CD3+、CD4+水平显著高于A组，C组上升更加明显。在IL-2水平方面，C组术后呈现上升趋势，术后7 d与术前比较，差异有统计学意义(P< 0.05)；B组和A组术后1、3 d较术前明显降低(P< 0.05)；术后1、3 d，C组与A组比较，差异有统计学意义(P< 0.05)。在IL-6水平方面，3组患者术后1 d均出现上升趋势(P< 0.05)；术后1、3 d，B组与A组比较，差异有统计学意义(P< 0.05)。在TNF-α水平方面，C组术后1、3、7呈现下降趋势，术后3、7 d与术前比较，差异有统计学意义(P< 0.05)；C组与A组比较，差异有统计学意义(P< 0.05)；B组术后1、3 d呈现上升趋势，与A组比较，差异有统计学意义(P< 0.05)。结论 对于胃癌根治术患者，在术前给予羟乙基淀粉输注，能够改善患者围术期的T细胞免疫功能，对术后炎症因子的水平产生了一定的抑制作用。Abstract: Objective To investigate the effect of preoperative infusion of hydroxyethyl starch on T cell subsets and inflammatory factors in patients undergoing radical gastric cancer surgery.Methods Patients undergoing radical gastric cancer surgery in our hospital from May 2020 to May 2021 were selected as the study objects, a total of 90 cases were grouped by random number table method and divided into three groups named A, B, and C, 30 cases in each group. All patients received radical gastric cancer surgery. Before surgery, group A was given compound sodium chloride injection, group B was given polygelatin injection, and group C patients was given hydroxyethyl starch injection. The patients' cubital venous blood was taken for determination of related indicators, including T lymphocyte subsets CD3+, CD4+, CD8+ and inflammatory factors IL-2, IL-6, and TNF-α before surgery and 1 d, 3 d, and 7 d after surgery.Results Before surgery, there was no significant difference in T cell subsets and inflammatory factors among three groups of patients (P>0.05). CD3+ and CD4+ levels were significantly lower than those before surgery on the 1 d and 3 d after surgery among three groups of patients (P< 0.05). The CD4+ levels in group B were significantly lower than that in group A (P< 0.05) 1 d after surgery; The levels of CD3+ and CD4+ in groups C and B were significantly higher than those in group A, and the increase in group C was more obvious 3 d after surgery. In terms of IL-2 level, group C showed an upward trend after surgery, on the 7 d after surgery compared with preoperative, there was a significant statistical difference (P< 0.05); Group B and group A were significantly lower on 1 d and 3 d after surgery than before surgery (P< 0.05); On the 1 d and 3 d after operation, there was a significant statistical difference between group C and group A (P< 0.05). In terms of IL-6 level, the three groups showed an upward trend on the 1 d after surgery (P< 0.05); 1 d and 3 d after surgery, there was a significant statistical difference between group B and group A (P< 0.05). In terms of TNF-α level, group C showed a downward trend at 1 d, 3 d, and 7 d after surgery; Compared with preoperative at 3 d and 7 d after surgery, there were significant statistical differences between group C and group A (P< 0.05), group B showed an upward trend at 1 d and 3 d after surgery, which was statistically significant compared with group A (P< 0.05).Conclusion For patients undergoing radical gastric cancer surgery, hydroxyethyl starch infusion before surgery improved patients' perioperative T cell immune function and had a certain inhibitory effect on the level of postoperative inflammatory factors.
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Key words:
- radical gastric cancer /
- hydroxyethyl starch /
- T cell subsets /
- inflammatory factors
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表 1 手术前后3组患者T淋巴细胞亚群变化情况
X±S 组别 CD3+/% CD4+/% CD8+/% CD4+/CD8+ A组 术前 63.28±8.96 42.34±8.98 28.19±6.79 1.65±0.55 术后1 d 46.96±10.241) 25.66±8.291) 27.18±7.20 1.08±0.341) 术后3 d 49.29±10.221) 31.39±7.391) 26.86±7.44 1.22±0.45 术后7 d 57.38±11.29 39.29±8.19 26.39±9.21 1.63±0.49 B组 术前 62.08±9.11 40.92±8.22 28.49±8.14 1.62±0.89 术后1 d 45.49±8.111) 21.19±8.021)2) 28.99±9.44 0.89±0.421) 术后3 d 55.68±11.091)2) 33.49±6.491)2) 28.29±8.20 1.34±0.41 术后7 d 62.24±8.44 48.14±9.25 28.99±10.22 1.59±0.88 C组 术前 60.21±10.24 40.75±8.11 29.44±7.20 1.41±0.59 术后1 d 45.24±6.941) 25.32±7.241) 28.03±8.29 1.09±0.351) 术后3 d 56.22±10.451)2) 35.87±8.111)2) 29.94±9.55 1.38±0.39 术后7 d 58.29±9.33 38.39±7.99 28.11±8.93 1.49±0.62 与同组术前比较，1)P < 0.05；与A组同时间点比较，2)P < 0.05。 
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表 2 手术前后3组患者炎症因子表达水平变化
ng/L，X±S 组别 IL-2 IL-6 TNF-α A组 术前 49.34±5.18 15.28±5.16 24.91±3.79 术后1 d 42.66±8.291) 77.96±19.241) 25.18±2.20 术后3 d 42.39±9.391) 39.29±18.22 26.55±1.44 术后7 d 48.29±8.19 19.38±8.29 24.39±3.21 B组 术前 47.92±8.02 19.08±7.21 24.49±4.04 术后1 d 42.19±9.021) 135.49±78.111)2) 28.99±7.441)2) 术后3 d 42.49±5.491) 104.68±77.091)2) 31.29±8.201)2) 术后7 d 49.14±17.25 36.24±18.44 25.99±8.22 C组 术前 48.75±7.11 12.21±8.14 24.02±3.20 术后1 d 49.32±9.242) 75.24±26.941) 20.53±5.292) 术后3 d 51.87±8.112) 37.22±20.451) 19.94±6.551)2) 术后7 d 52.39±7.991) 22.29±9.33 18.11±4.931)2) 与同组术前比较，1)P < 0.05；与A组同时间点比较，2)P < 0.05。
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[1] Boermeester MA, Sandick JV, Gisbertz SS, et al. Preoperative CD4+ and CD8+ T cell subsets and cytokine production in relation to prognosis in patients with adenocarcinoma of the oesophagus or oesophagogastric junction[J]. Gastroenterology, 2000, 118(4): A1381-A1381.
[2] Manilich E, Vogel JD, Kiran RP, et al. Key factors associated with postoperative complications in patients undergoing colorectal surgery[J]. Dis Colon Rectum, 2013, 56(1): 64-71. doi: 10.1097/DCR.0b013e31827175f6
[3] Qiu L, Yang J, Wang H, et al. Expression of T-helper-associated cytokines in the serum of pituitary adenoma patients preoperatively and postperatively[J]. Medical Hypotheses, 2013, 80(6): 781-786. doi: 10.1016/j.mehy.2013.03.011
[4] 张冬梅, 汪福珍. 自体血回收机联合白细胞过滤器对剖宫产患者T细胞亚群和炎症细胞因子的影响[J]. 临床血液学杂志, 2020, 33(2): 116-119. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXZ202002011.htm
[5] Sandick J, Boermeester M, Gisbertz S, et al. Lymphocyte subsets and T(h)1/T(h)2 immune responses in patients with adenocarcinoma of the oesophagus or oesophagogastric junction: relation to pTNM stage and clinical outcome[J]. Cancer Immunol Immunother, 2003, 52(10): 617-624. doi: 10.1007/s00262-003-0406-7
[6] Sagan A, Mrowiecki W, Mikolajczyk T, et al. Local inflammation is associated with aortic thrombus formation in abdominal aortic aneurysms[J]. Thromb Haemost, 2012, 108(11): 812-823. doi: 10.1160/TH12-05-0339
[7] Mei HF, Jin XB, Zhu JY, et al. β-defensin 2 as an Adjuvant Promotes Anti-Melanoma Immune Responses and Inhibits the Growth of Implanted Murine Melanoma In Vivo[J]. Plos One, 2012, 7(2): e31328. doi: 10.1371/journal.pone.0031328
[8] Körber N, Behrends U, Protzer U, et al. Evaluation of T-activated proteins as recall antigens to monitor Epstein-Barr virus and human cytomegalovirus-specific T cells in a clinical trial setting[J]. J Transl Med, 2020, 18(1): 242-242. doi: 10.1186/s12967-020-02385-x
[9] Park HB, Pei CZ, Do H A, et al. P-421 Down-expression of glycolytic pathway-related protein A1 is associated with the pathogenesis of recurrent pregnancy loss[J]. Human Reproduction, 2021.
[10] 高鲁渤, 杨丽, 李锦城. 输血与输羟乙基淀粉对人体T细胞亚群和细胞因子的影响[J]. 中华血液学杂志, 2003, 24(5): 265-267. doi: 10.3760/j:issn:0253-2727.2003.05.014
[11] 杨丽. 胃癌根治术中输注羟乙基淀粉对T淋巴细胞的影响[D]. 天津: 天津医科大学, 2002.
[12] 陈林涛. 羟乙基淀粉与乳酸林格液在胃癌根治术患者中的应用效果分析[J]. 海峡药学, 2018, 30(10): 2. https://www.cnki.com.cn/Article/CJFDTOTAL-HAIX201810081.htm
[13] 甘建辉, 李峰, 刘利祥, 等. 6%羟乙基淀粉130/0.4对胃癌根治术患者血浆细胞因子的影响[C]//第五届全国中医药免疫学术研讨会——暨环境·免疫与肿瘤防治综合交叉会议, 2009: 407.
[14] 王晓明. 不同人工胶体对胃癌根治术患者凝血功能的影响[D]. 保定: 河北大学, 2010.
[15] 高鲁渤, 杨丽, 李锦城. 输血与输羟乙基淀粉对人体T细胞亚群和细胞因子的影响[J]. 中华血液学杂志, 2003. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHXY200305018.htm
[16] 吴贵阳, 朱雄文, 陈再平. 羟乙基淀粉在老年胃癌根治术前应用的临床意义[J]. 中国生化药物杂志, 2016(12): 157-159. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYW201612045.htm
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