右美托咪定和丙泊酚对健康受试者体内循环细胞因子水平的影响

右美托咪定对免疫系统具有抑制作用,而丙泊酚对免疫系统具有促炎和抗炎双重作用。本研究揭示对免疫防御机制受损的患者麻醉时,麻醉药物的合理选择十分重要。

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The influence of dexmedetomidine and propofol on circulating cytokine levels in healthy subjects

背景与目的

手术和疾病会改变炎症反应和免疫系统。麻醉药物也对人体免疫系统有影响,但这种影响可能会因手术过程或潜在疾病而改变。本研究目旨在评估无任何手术干预情况下,单一使用右美托咪定和丙泊酚麻醉是否能改变健康受试者的急性免疫生物标志物。

方  法

随机对35名健康年轻男性受试者使用右美托咪定(n = 18)或异丙酚(n = 17)进行麻醉,直到受试者意识消失(LOR)。采用多参数免疫分析法检测48种细胞因子、趋化因子和生长因子水平。每个受试者在基线和最高药物浓度下测定药物浓度。

结  果

两组间嗜酸性粒细胞趋化因子(右旋美托咪啶治疗后下降)和血小板衍生生长因子(PDGF)浓度变化差异有统计学意义(P<0.05),丙泊酚治疗后两组患者血小板衍生生长因子(PDGF)浓度升高,差异有统计学意义(P<0.05)。两组均检测到显着变化;给药后两组单核细胞趋化蛋白1,趋化因子配体27和巨噬细胞迁移抑制因子的浓度均较低。右旋美托咪啶降低了嗜酸性粒细胞趋化因子,白介素-18,白介素-2Rα,干细胞因子,干细胞生长因子和血管内皮生长因子的浓度,丙泊酚显著降低肝细胞生长因子、干扰素-γ诱导的蛋白10和干扰素-γ诱导的单核细胞因子水平,升高白细胞介素-17、白细胞介素-5、白细胞介素-7和血小板衍生生长因子的水平。



结  论

右美托咪定对免疫系统具有抑制作用,而丙泊酚对免疫系统具有促炎和抗炎双重作用。本研究揭示对免疫防御机制受损的患者麻醉时,麻醉药物的合理选择十分重要。

原始文献摘要

Minna Kallioinen, Annalotta Scheinin, Mikael Maksimow,et,al. The influence of dexmedetomidine and propofol on circulating cytokine levels in healthy subjects. BMC Anesthesiology 2019;19:222

Background: Surgery and diseases modify inflammatory responses and the immune system. Anesthetic agents also have effects on the human immune system but the responses they induce may be altered or masked by the surgical procedures or underlying illnesses. The aim of this study was to assess how single-drug dexmedetomidine and propofol anesthesia without any surgical intervention alter acute immunological biomarkers in healthy subjects.
Methods: Thirty-five healthy, young male subjects were anesthetized using increasing concentrations of dexmedetomidine (n = 18) or propofol (n = 17) until loss of responsiveness (LOR) was detected. The treatment allocation was randomized. Multi-parametric immunoassays for the detection of 48 cytokines, chemokines and growth factors were used. Concentrations were determined at baseline and at the highest drug concentration for each subject.
Results: The changes in the concentration of eotaxin (decrease after dexmedetomidine) and platelet-derived growth factor (PDGF, increase after propofol) were statistically significantly different between the groups. Significant changes were detected within both groups; the concentrations of monocyte chemotactic protein 1, chemokine ligand 27 and macrophage migration inhibitory factor were lower in both groups after the drug administration.Dexmedetomidine decreased the concentration of eotaxin, interleukin-18, interleukin-2Rα, stem cell factor, stem cell growth factor and vascular endothelial growth factor, and propofol decreased significantly the levels of hepatocyte growth factor, IFN-γ-induced protein 10 and monokine induced by IFN-γ, and increased the levels of interleukin-17,interleukin-5, interleukin-7 and PDGF.
Conclusions: Dexmedetomidine seemed to have an immunosuppressive effect on the immune system whereas propofol seemed to induce mixed pro- and anti-inflammatory effects on the immune system. The choice of anesthetic agent could be relevant when treating patients with compromised immunological defense mechanisms.

贵州医科大学高鸿教授课题组

翻译:唐剑    编辑:冯玉蓉      审校:王贵龙

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