【罂粟摘要】右美托咪定对术后镇痛过程中CD4+ T细胞和程序性细胞死亡蛋白-1的影响：一项前瞻性、随机、对照研究

右美托咪定对术后镇痛过程中CD4+ T细胞和程序性细胞死亡蛋白-1的影响：一项前瞻性、随机、对照研究

贵州医科大学  麻醉与心脏电生理课题组

翻译:李奕    编辑：马艳燕    审校：曹莹

背景：手术创伤可能引起多种应激反应，这些应激反应可抑制免疫功能，加重炎症反应，最终导致患者预后不良。右美托咪定用于术后镇痛可产生阿片类药物保留效应同时并影响免疫反应。

方法：纳入86例手术患者，接受术后患者自控静脉镇痛（PCIA），芬太尼单独使用（芬太尼组）或与右美托咪定联合使用（右美托咪定组）。检测T辅助细胞（Th1、Th2和Th17）和调节性T细胞（Treg）的百分比、CD4+ T细胞上程序性细胞死亡蛋白-1（PD-1）及其配体（PD-L1）的表达水平以及细胞因子的血浆水平。术后疼痛采用数值评分量表（NRS）测量，包括静息时NRS（NRSR）和运动时NRS（NRSM）。

结果：右美托咪定组Th1细胞在术后24h和48 h显著增加（P=0.011和P=0.013），Treg细胞在术后48 h显著升高（P=0.013）。右美托咪定组术后24h PD-1显著降低（P=0.046），白细胞介素4（IL-4）和IL-6在术后48 h显著降低(P=0.024和P=分别为0.035）。与芬太尼组相比，右美托咪定组术后24 h NRSR评分较低（P=0.018），术后48 h NRSR和NRSM评分较低（P=0.007，P=0.011）。NRSR与芬太尼组和右美托咪定组的Th1细胞呈负相关（P=分别为0.003和P=分别为0.005）。

结论：右美托咪定可增加Th1和Treg细胞的分化，降低CD4+ T细胞上PD-1的表达，并且可能有助于改善术后疼痛和减轻促炎反应。疼痛与Th1细胞之间可能呈负相关。

原始文献来源：Yulan Wang , Yishan Lei , Yanzheng Gu, et al. Effect of dexmedetomidine on CD4+ T cells and programmed cell death protein-1 in postoperative analgesia: a prospective, randomized, controlled study.[J].Minerva Anestesiol. 2021 Apr;87(4):423-431.

英文原文：

Effect of dexmedetomidine on CD4+ T cells and programmed cell death protein-1 in postoperative analgesia: a prospective, randomized, controlled study

Background:Surgical trauma inhibits cellular immunity. Dexmedetomidine produces opioid-sparing effect and an impact on immune response.

Method:Eighty-six surgical patients were enrolled and received postoperative patient-controlled intravenous analgesia (PCIA) with either fentanyl alone (fentanyl group) or combined with dexmedetomidine (dexmedetomidine group). the percentages of t helper cells (th1, th2, and th17) and regulatory t (treg) cells, expression levels of programmed cell death protein-1 (PD-1) and its ligand (PD-l1) on the cD4+ T cells, and plasma levels of the cytokines were tested. Postoperative pain was measured by numerical rating scale (NRS), including NRS at rest (NRSR) and movement (NrsM).

Results:In dexmedetomidine group, Th1 cells were increased significantly at 24 and 48 h following surgery (P=0.011 and P=0.013, respectively) and Treg cells were significantly higher at 48 h postoperatively (P=0.013). PD-1 was significantly lower in dexmedetomidine group at 24 h postoperatively (P=0.046) and interleukin 4 (IL-4) and IL-6 were significantly decreased at 48 h postoperatively (P=0.024 and P=0.035, respectively). Compared with fentanyl group, NRSR scores were lower in dexmedetomidine group at 24 h following surgery (P=0.018) and NRSR and NRSM scores were lower at 48 h postoperatively (P=0.007 and P=0.011, respectively). NRSR exhibited negative correlations with Th1 cells in fentanyl group and dexmedetomidine group (P=0.003 and P=0.005, respectively).

Conclusion:Dexmedetomidine increases the differentiation of th1 and treg cells and reduces the expression of PD-1 on cD4+ T cells. Dexmedetomidine may assist to ameliorate postoperative pain and attenuate proinflammatory response. There might be a negative correlation between pain and Th1 cells.

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