摘要
目的 动态观察围术期患者外周血单核细胞β2整合素族的白细胞功能相关抗原(LFA-1即CD11a/CD18)和巨噬细胞分化抗原(Mac-1即CD11b/CD18)阳性表达率的变化情况,并比较不同手术创伤对其表达的影响。方法 选择择期手术患者24例,其中髋关节置换手术为Ⅰ组(n=10),下腹部手术为Ⅱ组(n=14)。所有患者均采用腰硬联合麻醉,且阻滞效果确切。分别于术前、术毕、术后第1天、术后第3天采集外周静脉血,采用免疫荧光流式细胞检测术,测定外周血单核细胞膜上CD11a/CD18、CD11b/CD18阳性表达率(％)。另选14位健康志愿者作对照测定正常值。结果 与正常对照值相比,两组围术期各时点CD11b/CD18差异均显著性增高30％-45％(P<0.01),而CD11a/CD18差异无显著性(P>0.05)。与术前相比,两组在术毕及术后第1天CD11b/CD18均显著性增高(P<0.05),术后第3天差异无显著性。CD11b/CD18在术后第1天Ⅰ组较Ⅱ组有显著性增高(P<0.05)。结论 围术期患者外周血单核细胞CD11b/CD18阳性表达率显著性上调,髋关节置换手术患者在术后24h的阳性表达上调较下腹部手术患者更显著;单核细胞可能主要通过CD11b/CD18介导而发挥多种功能。
Objective To investigate the changes in the expression of leukocyte function-related antigen-1 (LFA or CD11a/ CD18 ) and macrophage differentiation antigen-1 (Mac-1 or CD11b/CD18 ) on monocytes in the venous blood of the patients during perioperative period and the effects of different types of surgery. Methods Twenty-four ASA Ⅰ- Ⅲ patients aged 35-72 yr were divided into two groups according to the types of surgery : group Ⅰ total hip replacement (n = 10) and group Ⅱ lower abdominal surgery ( n = 14). The operations were performed under combined spinal-epidural anesthesia (CSEA) performed at L2-3. 0.75% bupivacaine 1.5-2.5 ml was injected into subarachnoid space and 0. 75% bupivacaine + 2% lidocaine were given epidurally. The block height was maintained at T6-10 . Venous blood samples were taken before operation (T0 ) , at the end of operation (T1 ) , on the 1st and 3rd postoperative days (T2 , T3 ) , for the determination of the positive expressions of CD11a/ CD18 and CD11b /CD18 on the monocytes using immunofluorescence flow cytometry. From 14 volunteere venous blood samples were taken to determine the normal value of CD11a CD18 and CD11b/ CD18 .Results Compared with the normai control (volunteere) , the rate of positive expression of CD11b/ CD18 increased by 30%-45% in group Ⅰ and Ⅱ (P <0. 05) , but there was no significant difference in the rate of positive expression of CD11a/ CD18 between the surgical patients (group Ⅰ , Ⅱ) and volunteere. The rate of positive expression of CD11b/ CD18 at T1 and T2 was significantly higher than that at T0 (before operation) in group Ⅰ and Ⅱ ( P < 0.05) and returned to preoperative level at T3 (the 3rd postoperative day). The rate of positive expression of CD11b/ CD18 at T2 (on the 1st postoperative day) was significantly higher in group I than that in group Ⅱ ( P < 0.05) . Conclusion The rate of positive expression of CD11b/ CD18 is significantly upregulated in surgical patients during perioperative period. The upregulation is more pronounced in patients undergoing total hip replacement than those undergoing lower abdominal surgery. CD11b/ CD18 may play an important role in the functioning of monocytes.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2004年第1期18-20,共3页
Chinese Journal of Anesthesiology
