摘要
目的:探讨全凭静脉麻醉和乳腺癌根治术对术前化疗与非化疗患者围术期T淋巴细胞亚群及自然杀伤细胞(NK细胞)的影响,并通过测定CK19 mRNA来判断乳腺癌细胞的微转移情况。方法:随机选择术前化疗与非化疗乳腺癌患者各20例,分为两组:Ⅰ组为术前未化疗组,Ⅱ组为术前化疗组。分别于麻醉前、术毕和术后72h抽取外周血11ml测定T细胞亚群、NK细胞的数量及CK19 mRNA的表达情况。结果:与麻醉前相比,两组术毕和术后72hCD3+、CD8+和NK细胞均下降,其中I组CD8+和NK细胞两个时点均下降明显(P<0.05),II组术毕和术后72hCD8+及术后72hNK细胞下降明显(P<0.05),两组间比较差异无显著性。与麻醉前相比,两组术毕和术后72hCD4+及CD4+/CD8+均升高,其中I组术毕和术后72h及II组术毕CD4+/CD8+升高明显(P<0.05),II组术后72hCD4+/CD8+显著升高(P<0.01)。两组均有3例患者检测到CK19 mRNA的表达,且Ⅱ期乳腺癌患者的表达较Ⅰ期显著增高(P<0.05)。结论:全凭静脉麻醉和乳腺癌根治术对术前化疗与非化疗患者的免疫系统有一定的抑制作用,而这种抑制作用与患者术前是否进行辅助化疗无关;同时乳腺癌患者存在微转移迹象。
Objective： To evaluate the effects of Total Intravenous Anesthesia （TIVA） on T lymphocyte subsets and NK cells in breast cancer patients undergoing radical mammotomy who was used chemicahherapy or not used chemicahherapy preoperation, and detect the micrometastases status in peripheral blood of those patients by reverse transcripition-polymerise chain reaction（RT-PCR）. Methods： Twenty brest cancer patients were used chemicahherapy and twenty brest cancer patients were not used chemicaltherapy were randomly chosen and divided into two group, Group 1 without chemicahherapy and group 2 with ehemieahherapy. 1 1ml peripheral venous blood samples were taken before anesthesia, after operation and 72 hours postoperation, 1ml was for determining T-lymphocyte CD3＋,CD4＋,CD8＋,CD4＋/CD8＋ and NK cells by floweytomete and 10ml was for detecting the CK19mRNA using RT-PCR. Results： Compared with those groups before anesthesia, in group I the CD8＋,NK cells decreased after operation and 72 hours postoperation and significant differences were found （P〈0.05）;and significant differences were found in CD8＋ after operation and 72 hours postoperation and NK cells 72 hours postoperation in group Ⅱ（P〈0.05 ）. Between these two groups there was no significant differences. Compared with those groups before anesthesia, the CD4＋/CD8 ＋ in group Ⅰrose after operation and 72 hours postoperation and the CD4 ＋/CD8 ＋ ingroup Ⅱ rose after operation（P〈0.05）, and the CD4＋/CD8＋ in group II rose 72 hours postoperation （P〈0.01）.In cases of two groups , CK19 mRNA expression were detected in the peripheral venous blood, but in 11 stage patients it was much higher than Ⅰstage patients. Conclusion： After using TIVA to breast cancer patients undergoing radical mammotomy who was used chemicaltherapy or not used chemicaltherapy preoperation, there are depressant effect to the patient＇ s immunosystem, but there is no relation with the patients whether received chemotherapy. And in the patient＇s vessel blood there are micrometastases exist.
出处
《天津医科大学学报》
2008年第2期210-214,共5页
Journal of Tianjin Medical University
关键词
乳腺癌根治术
静脉麻醉
细胞免疫
化疗
微转移
Breast cancer radical correction
Intravenous anesthesia
Cellular immunity
Chemotherapy
Micrometastasis
