Anesthetic Technique and the Cytokine and Matrix Metalloproteinase Response to Primary Breast Cancer Surgery
Anesthetic Technique and the Cytokine and Matrix Metalloproteinase Response to Primary Breast Cancer Surgery
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DOI：
10.1097/aap.0b013e3181ef4d05
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发表时间：
2010-11-01
影响因子：
5.1
通讯作者：
Buggy, Donal J.
中科院分区：
文献类型：
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作者：
Deegan, Catherine A.;Murray, David;Buggy, Donal J.
背景：乳腺癌是女性最常见的恶性肿瘤。手术仍然是最有效的治疗方法。围手术期的几个因素，包括手术应激反应，许多麻醉剂和阿片类药物，对免疫功能产生不利影响。局部麻醉-镇痛可减轻围手术期免疫抑制。与接受七氟醚麻醉和阿片镇痛（七氟醚/阿片）的患者相比，接受丙泊酚/椎旁麻醉-镇痛（丙泊酚/椎旁麻醉-镇痛）的患者表现出降低的致瘤细胞因子和基质金属蛋白酶（MMPs）水平和升高的抗肿瘤细胞因子水平。方法：将原发性乳腺癌手术患者随机分为异丙酚/脊髓旁治疗组（n = 15）和七氟醚/阿片类药物治疗组（n = 17），测定术前和术后血清中11种细胞因子（白介素1 β [IL-1 β]、IL-2、IL-4、IL-5、IL-6、IL-8、IL-10、IL-12p70、IL-13、干扰素γ和肿瘤坏死因子α）和3种MMPs （MMP-1、MMP-3和MMP-9）的浓度。结果：各治疗组在年龄、体重、手术方式、肿瘤病理诊断等方面平衡良好。与吗啡相比，椎旁镇痛在1和2小时时疼痛评分较低，但在24小时时相似。病人异丙酚/脊椎旁组表现出更大的百分比减少术后与术前相比il - 1β(中等(四分位数),-26%(-15%到-52%)和-4%(-14%到2%),P = 0.003),显著衰减MMP-3升高(2%(-39%到12%)和29% (23% - -59%),P = 0.011)和MMP-9(26%(13% - -54%)和74% (50% - -108%),P = 0.02),并显著增加il - 10(10%(5% - -33%)和-15%(20%到-2%),P = 0.001)和七氟醚/阿片类药物组相比。两组间IL-2、IL-4、IL-5、IL-6、IL-8、IL-12p70、IL-13、干扰素γ、肿瘤坏死因子α、MMP-1水平无明显变化。结论：异丙酚/椎旁麻醉-镇痛在乳腺癌手术中改变了少数影响围手术期肿瘤免疫调节的细胞因子。需要进一步评价以确定这些观察结果的重要性。
Background: Breast cancer is the most common malignancy in women. Surgery remains the most effective treatment. Several perioperative factors, including the surgical stress response, many anesthetics and opioids, adversely affect immune function. Regional anesthesia-analgesia attenuates perioperative immunosuppression. We tested the hypothesis that patients who receive combined propofol/paravertebral anesthesia-analgesia (propofol/paravertebral) exhibited reduced levels of protumorigenic cytokines and matrix metalloproteinases (MMPs) and elevated levels of anti-tumorigenic cytokines compared with patients receiving sevoflurane anesthesia with opioid analgesia (sevoflurane/opioid).Methods: Primary breast cancer surgery patients were randomized to propofol/paravertebral (n = 15) or sevoflurane/opioid (n = 17) and preoperative and postoperative serum concentrations of 11 cytokines (interleukin 1 beta [IL-1 beta], IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, IL-13, interferon gamma, and tumor necrosis factor alpha) and 3 MMPs (MMP-1, MMP-3, and MMP-9) were measured.Results: Treatment groups were well balanced for age, weight, surgical procedure, and cancer pathologic diagnosis. Pain scores were lower at 1 and 2 hrs with paravertebral analgesia compared with morphine but similar at 24 hrs. Patients in the propofol/paravertebral group showed a greater percentage decrease in postoperative compared with preoperative IL-1 beta (median [quartiles], -26% [-15% to -52%] versus -4% [-14% to 2%], P = 0.003), a significant attenuation in elevated MMP-3 (2% [-39% to 12%] versus 29% [23%-59%], P = 0.011) and MMP-9 (26% [13%-54%] versus 74% [50%-108%], P = 0.02), and a significant increase in IL-10 (10% [5%-33%] versus -15% [20% to -2%], P = 0.001) compared with sevoflurane/opioid group. No significantly different changes in IL-2, IL-4, IL-5, IL-6, IL-8, IL-12p70, IL-13, interferon gamma, tumor necrosis factor alpha, or MMP-1 were observed between the 2 groups.Conclusions: Propofol/paravertebral anesthesia-analgesia for breast cancer surgery alters a minority of cytokines influential in regulating perioperative cancer immunity. Further evaluation is required to determine the significance of these observations.