[1]周世凤,詹　玮,边成富.右美托咪定对行肝叶切除术原发性肝癌患者氧化应激、肝功能及外周血单核细胞内Toll样受体2和Toll样受体4表达的影响[J].新乡医学院学报,2020,37(9):869-872.[doi:10.7683/xxyxyxb.2020.09.015]
　ZHOU Shifeng,ZHAN Wei,BIAN Chengfu.Effect of dexmedetomidine on oxidative stress，liver function and expression of Toll-like receptor 2 and Toll-like receptor 4 in peripheral blood monouclear cells in patients with primary liver cancer undergoing hepalobectomy[J].Journal of Xinxiang Medical University,2020,37(9):869-872.[doi:10.7683/xxyxyxb.2020.09.015]
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右美托咪定对行肝叶切除术原发性肝癌患者氧化应激、肝功能及外周血单核细胞内Toll样受体2和Toll样受体4表达的影响
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
37
期数:
2020年9
页码:
869-872
栏目:
临床研究
出版日期:
2020-09-05

文章信息/Info

Title:
Effect of dexmedetomidine on oxidative stress，liver function and expression of Toll-like receptor 2 and Toll-like receptor 4 in peripheral blood monouclear cells in patients with primary liver cancer undergoing hepalobectomy
作者:
周世凤1; 詹　玮2; 边成富1
（1.凉山彝族自治州第二人民医院麻醉科，四川　凉山　615000；2.贵州医科大学附属医院普通外科，贵州　贵阳　550000）
Author(s):
ZHOU Shifeng1; ZHAN Wei2; BIAN Chengfu1
(1.Department of Anesthesia，the Second People′s Hospital of Liangshan Yi Autonomous Prefecture，Liangshan 615000，Sichuan Province，China;2.Department of General Surgery，the Affiliated Hospital of Guizhou Medical University，Guiyang 550000，Guizhou Province，China)
关键词:
原发性肝癌; 肝叶切除术; 右美托咪定; 氧化应激; 肝功能; Toll样受体2; Toll样受体4
Keywords:
primary liver cancer; hepalobectomy; dexmedetomidine; oxidative stress; liver function; Toll-like receptor 2; Toll-like receptor 4
分类号:
R735.7
DOI:
10.7683/xxyxyxb.2020.09.015
文献标志码:
A
摘要:
目的　探讨右美托咪定对行肝叶切除术的原发性肝癌（PLC）患者免疫功能、氧化应激、肝功能及外周血单核细胞内Toll样受体2（TLR2）和Toll样受体4（TLR4）表达的影响。方法　选择2015年11月至2019年1月于凉山彝族自治州第二人民医院行肝叶切除术的83例PLC患者为研究对象，采用随机数字表法将患者分为观察组（n=40）和对照组（n=43）。观察组患者麻醉诱导前给予盐酸右美托咪定注射液1 μg·kg-1，静脉滴注10 min，然后静脉滴注盐酸右美托咪定注射液0.5 μg·kg-1·h-1至手术结束。对照组患者麻醉诱导前静脉滴注等体积的生理盐水。分别于手术前和手术后即刻采集患者外周静脉血，使用CytoFLEX流式细胞仪检测T细胞亚群（CD3+、CD4+、CD4+/CD8+）及外周血单核细胞TLR2、TLR4阳性表达率，采用酶联免疫法测定血清中超氧化物歧化酶（SOD）、谷胱甘肽（GSH）、丙二醛（MDA）等氧化应激反应指标及天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、碱性磷酸酶（ALP）等肝功能指标的水平。结果　2组患者术前CD3+、CD4+、CD4+/CD8+水平比较差异无统计学意义（P>0.05）；2组患者术后CD3+、CD4+、CD4+/CD8+水平低于术前（P<0.05）；术后，观察组患者CD3+、CD4+、CD4+/CD8+水平高于对照组（P<0.05）。2组患者术前血清SOD、MDA、GSH水平比较差异无统计学意义（P>0.05）；与术前比较，2组患者术后血清SOD、GSH水平降低，血清MDA水平升高（P<0.05）；术后，观察组患者血清SOD、GSH水平高于对照组，血清MDA水平低于对照组（P<0.05）。2组患者术前血清ALT、AST、ALP水平比较差异无统计学意义（P>0.05）； 2组患者术后血清ALT、AST、ALP水平高于术前（P<0.05）；术后，观察组患者血清AST、ALT、ALP水平低于对照组（P<0.05）。2组患者术前外周血单核细胞TLR2和TLR4阳性表达率比较差异无统计学意义（P>0.05）； 2组患者术后外周血单核细胞TLR2和TLR4阳性表达率高于术前（P<0.05）；术后，观察组患者外周血单核细胞TLR4阳性表达率低于对照组（P<0.05），2组患者外周血单核细胞TLR2阳性表达率比较差异无统计学意义（P>0.05）。结论　右美托咪定可以减轻行肝叶切除术患者的应激反应和炎症反应，改善患者免疫功能和肝功能。
Abstract:
Objective　To investigate the effect of dexmedetomidine on the immune function，oxidative stress，liver function and the expression of Toll-like receptor 2 (TLR2) and Toll-like receptor 4 (TLR4) in peripheral blood monouclear cells in patients with primary liver cancer (PLC) undergoing hepalobectomy.Methods　A total of 83 PLC patients who underwent hepalobectomy in the Second People′s Hospital of Liangshan Yi Autonomous Prefecture from November 2015 to January 2019 were selected as the research subjects，and they were divided into observation group (n=40) and control group (n=43) by random number table.The patients in the observation group were given dexmedetomidine hydrochloride injection 1 μg·kg-1 for 10 minutes by intravenously guttae before anesthesia induction，then，they were given dexmedetomidine hydrochloride injection 0.5 μg·kg-1·h-1 by intravenously guttae until the end of operation.The patients in the control group were given the same volume of normal saline by intravenous drip before anesthesia induction.The peripheral venous blood of the patients was collected before and immediately after operation.The T cell subsets (CD3+，CD4+，CD4+/CD8+) and the positive expression rate of TLR2 and TLR4 in peripheral blood mononuclear cells were detected by CytoFLEX flow cytometry.The levels of serum oxidative stress indexes including superoxide dismutase (SOD)，glutathione (GSH)，malondialdehyde (MDA) and liver function indexes including aspartate aminotransferase (AST)，alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were detected by enzyme linked immunosorbent assay.Results　There was no significant difference in the levels of CD3+，CD4+，CD4+/CD8+ between the two groups before operation (P>0.05).The levels of CD3+，CD4+，CD4+/CD8+ after operation were lower than those before operation in the two groups (P<0.05).The levels of CD3+，CD4+，CD4+/CD8+ in the observation group were higher than those in the control group after operation (P<0.05).There was no significant difference in serum SOD，MDA and GSH levels between the two groups before operation (P>0.05).Compared with before operation，the levels of SOD and GSH decreased and the level of MDA increased after operation in the two groups (P<0.05).After operation，the levels of SOD and GSH in the observation group were higher than those in the control group，and the serum MDA level was lower than that in the control group (P<0.05).There was no significant difference in serum ALT，AST and ALP levels between the two groups before operation (P>0.05).The levels of serum ALT，AST and ALP after operation were higher than those before operation in the two groups (P<0.05).The levels of serum AST，ALT and ALP in the observation group were lower than those in the control group after operation (P<0.05).There was no significant difference in the positive expression rate of TLR2 and TLR4 in peripheral blood monouclear cells between the two groups before operation (P>0.05).The positive expression rate of TLR2 and TLR4 in peripheral blood mononuclear cells of the two groups after operation were higher than those before operation (P<0.05).After operation，the positive expression rate of TLR4 in peripheral blood mononuclear cells in the observation group was lower than that in the control group (P<0.05)，and there was no significant difference in the positive expression rate of TLR4 in peripheral blood mononuclear cells between the two groups (P>0.05).Conclusion　Dexmedetomidine can reduce the stress response and inflammatory reaction of patients undergoing hepalobectomy，and improve the immune function and liver function of patients.

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更新日期/Last Update: 2020-09-05