全凭静脉麻醉对新辅助化疗后行乳腺癌改良根治术患者外周血Treg细胞的影响

发布时间：2018-02-20 21:20

本文关键词： 乳腺癌 Treg细胞新辅助化疗全凭静脉麻醉　出处：《宁夏医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的探讨全凭静脉麻醉对新辅助化疗后乳腺癌改良根治术患者围术期T淋巴细胞亚群、Treg细胞、三系血细胞及肝肾功能的影响。方法第一部分:收集2010年1月1日至2012年12月31日期间在宁夏医科大学总医院肿瘤外科住院择期行乳腺癌根治手术患者病例资料1076例,整理资料后完全符合纳入标准和排除标准病例307例,根据术前是否行新辅助化疗分两组,其中化疗143例,非化疗组164例。分析统计两组患者术前、术后外周血白细胞计数、红细胞计数、血小板计数、谷草转氨酶、谷丙转氨酶、尿素氮及血肌酐数值。第二部分:选择自2013年3月至2013年12月在宁夏医科大学总医院肿瘤医院肿瘤外科住院且经病理学检查证实为女性乳腺癌患者58例,根据术前是否行化疗分为两组:C组27例,为非化疗组,N组31例,为化疗组。分别于麻醉诱导前(T0)、手术结束后(T1)、术后24小时(T2)抽取肘静脉血4ml,检测T细胞亚群及Treg细胞的数量。结果第一部分:化疗组较非化疗组术前WBC、RBC及PLC均减少(P0.05);化疗组术后较术前WBC、RBC、PLC呈进行性下降趋势,(P0.05);第二部分:两组患者术后外周血中的CD3+、CD4+、CD8+与诱导前相比均呈进行性下降趋势,与诱导前相比术后及术后24h均下降明显(P0.05);两组之间T0检测值进行比较均存在显著差异(P0.05);两组患者术后外周血Treg细胞比例较诱导前均呈进行性增长明显,(P0.05);两组之间个时间点检测值进行比较,术前及术毕两组存在差异,(P0.05)。结论第一部分:1)化疗组患者术前外周血白细胞计数、红细胞计数及血小板计数较非化疗组均受到不同程度的抑制。2)全凭静脉麻醉对新辅助化疗患者外周血白细胞计数、红细胞计数及血小板计数产生不同程度抑制,以对血小板抑制最强。3)全凭静脉麻醉对两组患者肝肾功能产生一定程度的抑制,但尚属正常范围。第二部分:1)应用全凭静脉麻醉对术前化疗与非化疗乳腺癌根治术患者的T淋巴细胞亚群均有一定的抑制作用,这种抑制作用与患者术前是否进行辅助化疗无关。2)化疗可降低乳腺癌患者外周血Treg细胞比例,从而减轻Treg细胞对的免疫抑制功能,全凭静脉麻醉可使乳腺癌患者外周血Treg细胞比例升高,对化疗后患者外周血Treg细胞比例下降产生逆转作用。
[Abstract]:Objective to investigate the effect of total intravenous anesthesia on T lymphocyte subsets (Treg cells) in patients with breast cancer undergoing modified radical mastectomy after neoadjuvant chemotherapy. Effects of three lineage blood cells and liver and kidney function. Methods: from January 1st 2010 to December 31st 2012, 1 076 cases of elective radical mastectomy for breast cancer were collected from January 1st 2010 to December 31st 2012 in the Department of Cancer surgery, Ningxia Medical University General Hospital. According to whether or not neoadjuvant chemotherapy was performed before operation, 143 cases received neoadjuvant chemotherapy and 164 cases in non-chemotherapy group were divided into two groups. Red blood cell count, platelet count, glutamic oxaloacetic transaminase, alanine aminotransferase, Values of urea nitrogen and serum creatinine. Part 2: 58 cases of female breast cancer confirmed by pathological examination were selected from March 2013 to December 2013 in tumor surgery Hospital, General Hospital of Ningxia Medical University. According to whether or not chemotherapy was performed before operation, 27 cases were divided into two groups: group C (n = 27) and group N (n = 31). The blood samples were taken from the cubital vein blood 4 ml before anesthesia induction and 24 hours after operation. The T cell subsets and the number of Treg cells were detected. Results the first part: compared with the non-chemotherapy group, the preoperative WBC and PLC in the chemotherapy group were lower than those in the non-chemotherapy group. In the chemotherapy group, there was a trend of progressive decrease in the number of CD3, CD 4, CD 4, CD 8 in the peripheral blood of the two groups compared with that before the induction, and in the second part, there was a progressive decrease in the number of CD3, CD 4, CD 4 and CD 8 in the peripheral blood of the patients in the two groups. Compared with before induction and 24 hours after induction, the ratio of Treg cells in peripheral blood of the two groups was significantly increased compared with that before induction, and there was a significant difference between the two groups in the detection of T0, the percentage of Treg cells in the peripheral blood of the two groups was significantly increased than that before induction, and between the two groups, there was a significant increase in the percentage of Treg cells in the peripheral blood of the two groups. To compare the detected values at three points in time, There was significant difference between the two groups before and after operation. Conclusion the white blood cell count in peripheral blood of the patients in the chemotherapy group before operation was lower than that in the control group. Red blood cell count and platelet count were inhibited by different degrees compared with non-chemotherapy group. 2) Total intravenous anesthesia inhibited peripheral white blood cell count, red blood cell count and platelet count in neoadjuvant chemotherapy patients to varying degrees. Total intravenous anesthesia inhibited liver and kidney function in both groups to a certain extent. Part 2: 1) Total intravenous anesthesia has a certain inhibitory effect on T lymphocyte subsets in both preoperative chemotherapy and non-chemotherapy radical mastectomy for breast cancer. The inhibitory effect was independent of preoperative adjuvant chemotherapy. 2) chemotherapy could reduce the proportion of Treg cells in peripheral blood of patients with breast cancer, thus reducing the immunosuppressive function of Treg cells. Total intravenous anesthesia could increase the proportion of Treg cells in peripheral blood of breast cancer patients and reverse the decrease of Treg cells in peripheral blood after chemotherapy.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614;R737.9

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