Randomized study of the benefits of preoperative corticosteroid administration on the postoperative morbidity and cytokine response in patients undergoing surgery for esophageal cancer
Randomized study of the benefits of preoperative corticosteroid administration on the postoperative morbidity and cytokine response in patients undergoing surgery for esophageal cancer
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DOI：
10.1097/00000658-200208000-00006
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发表时间：
2002-08-01
影响因子：
9
通讯作者：
Endo, S
中科院分区：
文献类型：
--
作者：
Sato, N;Koeda, K;Endo, S
目的探讨术前应用糖皮质激素是否能降低术后并发症。摘要背景资料：类固醇激素在缓解手术应激方面的有益作用尚未达成共识，共66例胸段食管癌手术患者在术前随机分为两组，每组33例。一组在手术前30分钟静脉输注甲泼尼龙（10 mg/kg体重）（MP组），而另一组接受安慰剂输注（对照组）。主要终点是术后前7天内的器官系统衰竭。比较手术相关的并发症，细胞因子反应，和血细胞计数也作出了两组之间。结果在MP组的患者中有一个或多个器官系统衰竭的百分比为33%，显着低于对照组的61%的相应百分比。两组手术相关并发症发生率和长期生存率相似。MP组血浆白细胞介素（IL）-1受体拮抗剂、IL-6和IL-8的峰值水平显著低于对照组。MP组血浆IL-10水平的变化显著更大。在循环淋巴细胞和中性粒细胞计数没有显着差异，观察groups.Conclusions结果表明，预防性使用皮质类固醇与减少在接受侵入性手术的患者术后发病率。实验室数据表明，皮质类固醇可以通过直接抑制促炎细胞因子的释放和诱导IL-10的合成来减弱手术应激诱导的炎症反应。
Objective To investigate whether preoperative corticosteroid administration plays a role in attenuating postoperative morbidity. Summary Background Data There is as yet no consensus on the beneficial effects of steroids in alleviating surgical stress.Methods A total of 66 patients undergoing surgery for thoracic esophageal cancer were randomly categorized preoperatively into two groups of 33 patients each. One group was administered an intravenous infusion of methylprednisolone (10 mg/kg body weight) 30 minutes before the surgery (MP group), while the other group received a placebo infusion (control group). The primary endpoint was organ system failure during the first 7 days after surgery. Comparisons of surgery-related complications, cytokine responses, and blood counts were also made between the two groups.Results The percentage of patients in the MP group who had one or more organ system failures was 33%, significantly lower than the corresponding percentage of 61% in the control group. The surgery-related complication rate and long-term survival rate were similar in the two groups. The peak plasma levels of interleukin (IL)-1 receptor antagonist, IL-6, and IL-8 were significantly lower in the MP group than in the control group. Changes in the plasma levels of IL-10 were significantly larger in the MP group. No significant differences in the circulating lymphocyte and neutrophil counts were observed between the groups.Conclusions The results suggest that prophylactic administration of corticosteroids is associated with a decrease in postoperative morbidity in patients undergoing invasive surgery. The laboratory data suggest that corticosteroids may attenuate surgical stress-induced inflammatory responses both directly by suppressing the release of proinflammatory cytokines and via inducing IL-10 synthesis.