丙泊酚联合氯胺酮麻醉对急性淋巴细胞白血病患儿外周血T淋巴细胞免疫功能的影响

目的观察丙泊酚联合氯胺酮麻醉对急性淋巴细胞白血病（ALL）患儿外周血T淋巴细胞免疫功能的影响。方法对照组为80例健康体检儿童，试验组为78例经骨髓穿刺确诊为ALL的患儿，试验组患儿鞘内注射化疗药物治疗，期间静脉注射丙泊酚（2±1）mg／kg]联合氯胺酮（0．5mg／kg）镇静麻醉，分别将经骨髓穿刺确诊镇静麻醉前、镇静麻醉6h后（即鞘内注射前）及镇静麻醉24h后（即鞘内注射并镇静麻醉18h后）的患儿血样设为TG-t0组、TG-t1组和TG-t2组。采用流式细胞仪对外周血T淋巴细胞亚群：CD3、CD4、CD8和CD4/CD8的水平和CD4＋CD25＋CD127．Treg细胞进行检测。以Ag-NORs、Th1／Th2比值及TGF-β作为免疫学指标，采用KL型肿瘤免疫图像分析系统对外周血Ag-NORs进行检测；采用酶联免疫吸附法检测Th1／Th2比值及TGF召的血清浓度水平。结果试验组患儿外周血CD8、Treg比例、TGF-β水平明显高于对照组，而CD3、CD4、CD4/CD8比值、Ag-NORs水平及Th1／Th2比值明显低于对照组，TG-t0组、TG-t1组和TG-t2组的T细胞亚群及相关免疫学指标差异均无统计学意义。结论ALL患儿较健康儿童机体免疫功能低下，而在诊断和术后使用丙泊酚联合氯胺酮麻醉对其外周血T淋巴细胞免疫功能改变无直接影响。

Effects of propofol combined with ketamin on the changes in immune function of T lymphocytes in peripheral blood from children with acute lymphocytic leukemia.

Objective To explore the effects ofpropofol combined with ketamin on the changes in immune function ofT lymphocytes in peripheral blood from children with acute lymphocytic leukemia （ALL）. Methods A total of 80 healthy children were selected as the control group, while 78 children with ALL diagnosed by bone marrow aspiration were enrolled as the study group. Patients in the study group undergoing lumber puncture with chemotherapeutics received sedation with IV propofol （2±1） mg/kg] and ketamine （0.5 mg/kg）. Blood samples of patients before sedation for bone marrow aspiration was represented as TG-t0, sedation 6 hours after TG-t0 （before lumber puncture with chemotherapeutics） was represented as TG-t1, and 24 hours after TG-t0 （during lumber puncture with chemothera- peutics sedation 18 hours） was represented as TG-t2. Levels of T lymphocyte subsets and CD4＋CD25＋CD127- Treg cells were detected by flow cytometry. The ratio of Ag-NORs, Th1/Th2 and TGF-β were used as cellular immune indicators. A KL image system was used to analyze the ratio of Ag-NORs of T lymphocytes, and ELISA assay was employed to investigate the Th1/Th2 and levels of TGF-β in serum. Results The proportion of CD8 cells and Treg cells and levels of TGF-β in serum from patients in the study group were higher than those of the control group. There were no significant differences in the levels of T lymphocyte subsets and cellular immune indicators among group TG-t0, group TG-t 1 and group TG-t2. Conclusion Children with ALL have lower immune function, and sedation with propofol-ketamine combination may not affect the immune function ofT lymphocytes in peripheral blood directly.