乌司他丁对围手术期食管癌患者细胞免疫功能的影响

目的 观察乌司他丁对围手术期食管癌患者细胞免疫功能的影响.方法 72 例食管癌患者随机分为乌司他丁组(U 组,n=36) 和对照组(C 组,n=36).U 组于麻醉诱导后、切皮前将乌司他丁20 万U 溶于0.9% 氯化钠注射液20ml 缓慢静脉推注,若手术时间>2h,则相同剂量追加1 次.C 组应用等量0.9% 氯化钠注射液.术前24h(T0)、手术90min(T1)、术后1d(T2)、3d(T3)、7d(T4) 采集血样,应用流式细胞仪测定T 细胞亚群含量及NK 细胞含量.结果 术前两组指标无统计学差异.T1、T2 和T3 时点C 组CD3+、CD4+、CD4+/CD8+ 以及NK 细胞含量较术前下降,CD8+ 较术前上升(P<0.05 或P<0.01),T4 时点除CD8+,CD4+/CD8+ 外,其他指标恢复到术前水平.U 组T1 时点各项指标与术前比较无明显变化(P>0.05),术后T2、T3和T4 时点CD3+、CD4+、CD4+/CD8+ 以及NK 细胞含量较术前上升,CD8+ 较术前下降(P<0.05 或P<0.01).术后两组各指标间差异有统计学意义(P<0.05 或P<0.01).结论 围手术期食管癌患者免疫功能下降,乌司他丁能促进T 细胞亚群恢复,对细胞免疫具有保护和提高作用.

Effect of ulinastatin on cell immunity in perioperative esophageal cancer patients

Objective To observe the effect of ulinastatin on cell immunity in perioperative esophageal cancer patients.Methods Seventy-two esophageal cancer patients were randomly divided into ulinastatin group(group U) and control group(group C),36 in each group.Patients in group U were intravenously injected with 20ml 0.9% sodium chloride solution containing ulinastatin(2×105unit)after anesthesia,which was repeated if the operation was longer than 2h.Those in group C were only injected with 20ml 0.9% sodium chloride solution.Blood samples were taken from both groups at 24h before operation(T0),90 minutes in operation(T1),on day 1 after operation(T2),on day 3 after operation(T3),on day 7 after operation(T4).The number of T lymphocyte subgroups(CD3+,CD4+,CD8+,CD4+/CD8+) and NK cells was calculated by flow cytometry.Results No significant difference was found in the number of T-lymphocyte subgroups and NK cells between the two groups at T0.The number of CD3+,CD4+,CD4+/CD8+ and NK cells was significantly lower and that of CD8+ was significantly higher at T1,T2,T3 than at T0 in group C(P<0.05 or P<0.01) and returned to the T0 level at T4 except for that of CD8+ and CD4+/CD8+.No significant difference was found in the number of T-lymphocyte subgroups and NK cells in group U at T1.The number of CD3+,CD4+,CD4+/CD8+ and NK cells was significantly higher and that of CD8+ was significantly lower in group U at T2,T3,T4 than at T0(P<0.05 or P<0.01).Conclusion The cell immunity in perioperative esophageal cancer patient is decreased.Ulinastatin can promote recovery of T-lymphocyte subgroups,thus protecting and improving the cell immunity of such patients.