摘要
目的研究糖尿病患者围手术期血浆及WBC源性强啡肽A(dynorphin A,DYN-A)含量变化。方法选择择期全身麻醉下行腰椎融合术(posterior lumbar interbody fusion,PLIF)的患者,分为非糖尿病组(NDM组,49例)和糖尿病组(DM组,23例)。记录患者手术前后外周血WBC总数及分类(淋巴细胞、单核细胞、粒细胞)计数。于麻醉前(T1)、麻醉结束苏醒后(T2)分别采集非输液侧肘静脉血3 ml,ELISA法测定血浆DYN-A水平,流式细胞术(flow cytometry,FCM)测定WBC中含DYN-A荧光阳性细胞百分数和平均荧光强度(mean fluorescence intensity,MFI)。结果T2时,NDM组患者外周血WBC总数[(12.9±4.1)×10^9/L比(6.3±1.6)×10^9/L]、粒细胞计数[(10.7±4.0)×10^9/L比(3.7±1.3)×10^9/L]、单核细胞计数[(0.66±0.30)×10^9/L比(0.46±0.15)×10^9/L]均高于T1时(P<0.05),淋巴细胞计数[(1.2±0.5)×10^9/L比(2.0±0.7)×10^9/L]明显低于T1时(P<0.05);DM组患者外周血WBC总数[(11.7±3.5)×10^9/L比(6.8±2.1)×10^9/L]、粒细胞计数[(9.6±3.9)×10^9/L比(4.1±2.1)×10^9/L]亦高于T1时(P<0.05),淋巴细胞计数[(1.1±0.4)×10^9/L比(1.8±0.6)×10^9/L]明显低于T1时(P<0.05),而T2时单核细胞计数呈现升高趋势。与T1时比较,DM组与NDM组T2时血浆DYN-A含量均显著降低(P<0.05)。与NDM组比较,DM组T1时淋巴细胞、单核细胞、粒细胞中含DYN-A荧光阳性细胞百分数均升高,差异有统计学意义(P<0.05)。与T1时比较,T2时DM组淋巴细胞、单核细胞、粒细胞中含DYN-A荧光阳性细胞百分数明显降低(P<0.05),而NDM组术后无明显变化(P>0.05)。与T1时比较,T2时NDM组粒细胞中含DYN-A MFI降低(P<0.05),DM组粒细胞中含DYN-A MFI呈降低趋势(P>0.05)。结论糖尿病患者围手术期外周血WBC总数升高,以粒细胞增高最为明显,而WBC分类中DYN-A阳性细胞比例明显降低,血浆及外周血粒细胞中DYN-A含量亦下降;上述变化与糖尿病围手术期应激和免疫状态有关。
Objective To investigate the changes of dynorphin A(DYN-A)in plasma and derived from peripheral white blood cells(WBCs)of diabetic patients during the perioperative period.Methods Patients scheduled for posterior lumbar interbody fusion(PLIF)under general anesthesia were selected and divided into two groups:a non-diabetes group(an NDM group,n=49)and a diabetes group(a DM group,n=23).The total number of peripheral WBCs and their classification such as lymphocytes,monocytes,and granulocytes were counted before and after operation.Before anesthesia(T1),and after awakening from anesthesia(T2),blood samples from the non-infusion sided elbow vein were collected.The plasma levels of DYN-A were measured by enzyme-linked immunosorbent assay(ELISA).Flow cytometry(FCM)was used to determine the percentage of DYN-A fluorescence positive cells and mean fluorescence intensity(MFI)of WBCs.Results In the NDM group,the total number of peripheral WBCs at T2[(12.9±4.1)×10^9/L]was remarkably higher than the count at T1[(6.3±1.6)×10^9/L](P<0.05).The granulocyte count at T2[(10.7±4.0)×10^9/L]was higher than the count at T1[(3.7±1.3)×10^9/L](P<0.05).The monocyte count at T2[(0.66±0.30)×10^9/L]was higher than the count at T1[(0.46±0.15)×10^9/L](P<0.05).The lymphocyte count at T2[(1.2±0.5)×10^9/L]was lower than the count at T1[(2.0±0.7)×10^9/L](P<0.05).In the DM group,the total number of peripheral WBCs at T2[(11.7±3.5)×10^9/L]was also higher than that at T1[(6.8±2.1)×10^9/L](P<0.05).The granulocyte count at T2[(9.6±3.9)×10^9/L]was higher than that at T1[(4.1±2.1)×10^9/L](P<0.05).The lymphocyte count at T2[(1.1±0.4)×10^9/L]was significantly lower than the count at T1[(1.8±0.6)×10^9/L](P<0.05).Also,the monocyte count at T2 increased.The level of plasma DYN-A significantly decreased in the NDM and DM groups at T2,compared with that at T1(P<0.05).Compared with the NDM group,the percentage of each type of WBCs with fluorescent positive DYN-A significantly increased at T1 in the DM group(P<0.05).Compared with those at T1,the percentage of each type of WBCs with fluorescent positive DYN-A remarkably reduced at T2 in the DM group(P<0.05).But there was no significant change in the NDM group after operation.Compared with those at T1,the MFI of DYN-A in granulocytes reduced at T2 in the NDM group(P<0.05),while the DM group showed decreases in the MFI of DYN-A at T2(P>0.05).Conclusions The total number of peripheral WBCs significantly increases in the diabetic patients during the perioperative period,with the most obvious increase in granulocyte count.The percentage of DYN-A positive cells in leukocyte classification significantly decreases,while the level of DYN-A in plasma and derived from granulocytes also decreases.These changes are related to the perioperative stress and immune status of the diabetic patients.
作者
胡旭兰
霍海燕
孟珊珊
张林忠
Hu Xulan;Huo Haiyan;Meng Shanshan;Zhang Linzhong(Department of Anesthesiology,Shanxi Medical University,Taiyuan 030001,China;Department of Anesthesiology,the Second Hospital of Shanxi Medical University,Taiyuan 030001)
出处
《国际麻醉学与复苏杂志》
CAS
2020年第1期53-57,共5页
International Journal of Anesthesiology and Resuscitation
基金
山西医科大学科技创新基金(01201513)。
关键词
糖尿病
围手术期
白细胞
强啡肽
Diabetes
Perioperative period
White blood cell
Dynorphin
