文章摘要
武长君,钱鹏.右美托咪定联合盐酸艾司洛尔对肺癌根治术病人肺保护作用及其对 Toll样受体 4/核因子 -κB信号通路的影响[J].安徽医药,2021,25(6):1246-1250.
右美托咪定联合盐酸艾司洛尔对肺癌根治术病人肺保护作用及其对 Toll样受体 4/核因子 -κB信号通路的影响
Effects of dexmedetomidine combined with esmolol on lung protection and its effect on TLR4/ NF-κB signaling pathway in patients with radical lung cancer
  
DOI:10.3969/j.issn.1009-6469.2021.06.046
中文关键词: 肺肿瘤  肺切除术  麻醉,静脉  右美托咪定  艾司洛尔  肺功能  炎症  氧化应激
英文关键词: Lung neoplasms  Pneumonectomy  Anesthesia, intravenous  Dexmedetomidine  Esmolol  Lung function  In flammation  Oxidative stress
基金项目:
作者单位
武长君 攀枝花市第二人民医院麻醉科四川攀枝花 617068 
钱鹏 攀枝花市第二人民医院麻醉科四川攀枝花 617068 
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中文摘要:
      目的探讨右美托咪定联合盐酸艾司洛尔对肺癌根治术病人肺保护作用及其对 Toll样受体 4/核因子 -κB(TLR4/NFκB)信号通路的影响。方法回顾性选取 2017年 10月至 2018年 12月攀枝花市第二人民医院择期行肺癌根治术的肺癌病人 80例为研究对象,根据治疗方法的不同将病人分为对照组与联合组,每组各 40例。对照组:应用右美托咪定;联合组:在对照组的基础上应用盐酸艾司洛尔。分别于术前( T1)、开胸后( T2)、单肺通气 60 min(T3)、手术结束时( T4),采用酶联免疫吸附测定( ELISA)检测血清炎性因子白细胞介素 -6(IL-6)、白细胞介素 -8(IL-8)、肿瘤坏死因子 α(TNF-α)的水平;采用 ELISA检测肺组织匀浆上清液中丙二醛、髓过氧化物(MPO)、黄嘌呤氧化酶(XOD)的水平;检测动脉血氧分压(PaO2)、氧合指数、气道平台压(APP)、气道阻力、中性粒细胞( PMN)数量;实时荧光定量逆转录聚合酶链反应( qRT-PCR)检测 TLR4、NF-κB mRNA的表达水平。结果用药和时间的交互作用对 IL-6、IL-8、TNF-α、丙二醛、 MPO、XOD、PaO2氧合指数、 APP、气道阻力、 PMN数量的影响差异有统计学意义( P<0.05),联合组在 T2、T3、T4时间点 IL-6[( 16.52±2.32)(/ 30.2、0±6.21)(/ 33.21±5.31)ng/L比( 29.63±8.52)/(42.36±10.19)(/ 55.41±6.85)ng/L]、 IL-8[( 9.62±1.03)(/ 11.52±2.11)(/ 18.24±1.54)ng/L比( 13.52±1.41)(/ 18.67±3.21)(/ 30.21± 3.52)ng/L]、 TNF-α[( 10.21±1.21)(/ 20.31±1.42)(/ 30.19±2.46)ng/L比( 15.42±3.32)(/ 39.47±6.21)(/ 45.41±6.16)ng/L]、丙二醛[( 5.63±0.22)(/ 5.72±0.21)(/ 6.32±0.33)mmol/L比( 10.32±1.03)(/ 12.31±1.01)(/ 15.62±1.12)mmol/L]、 MPO[( 6.35±1.02)(/ 7.31± 1.12)(/ 6.30±1.08)μg/L比( 8.35±1.13)(/ 11.21±1.30)(/ 12.13±0.56)μg/L]、 XOD[( 5.61±0.85)(/ 5.14±0.26)(/ 4.21±0.13)μg/L比(7.61±1.10)(/ 8.64±1.32)(/ 10.51±2.21)μg/L]、 APP[( 18.62±2.13)(/ 16.62±1.32)(/ 13.25±1.13)cmH2O比( 22.31±3.24)(/ 22.96± 2.18)(/ 15.32±1.02)cmH2O]、气道阻力[( 15.62±1.10)(/ 14.33±1.12)(/ 13.20±1.01)cmH2O/LS比( 17.92±1.16)(/ 16.34±1.05)/(15.39±0.25)cmH2O/LS]、 PMN[( 6.33±0.15)(/ 8.13±0.49)(/ 10.13±0.32)×109/L比( 8.22±1.56)(/ 12.42±1.55)(/ 13.52±0.62)×109/L]水平均明显低于对照组( P<0.05), [( 83.16±1.02)(/ 93.21±3.11)(/ 96.31±1.24)mmHg比( 80.21±1.33)(/ 82.31±5.21)(/ 90.32±PaO21.30)mmHg]、氧合指数[( 287.42±16.24)(/ 316.24±14.25)(/ 359.47±15.64)mmHg比( 222.31±15.67)(/ 286.51±14.52)(/ 312.31±11.27)mmHg]明显高于对照组( P<0.05);用药和时间的交互作用对 TLR4、NF-κB mRNA的表达量的影响差异有统计学意义( P <0.05),联合组在 T2、T3、T4时间点 TLR4[( 0.946±0.016)(/ 0.924±0.017)(/ 0.351±0.010)比( 0.983±0.021)(/ 0.985±0.017)(/ 0.679±0.014)]mRNA,T3、T4时间点 NF-κB mRNA表达量[(0.940±0.092)(/ 0.300±0.046)比(0.979±0.115)(/ 0.731±0.135)]明显低于对照组(均 P<0.05)。结论右美托咪定联合盐酸艾司洛尔可有效保护肺癌根治术病人肺功能,减轻炎症反应及氧化应激反应,其可能是通过抑制 TLR4/NF-κB信号通路而发挥作用。
英文摘要:
      Objective To investigate the protective effect of dexmedetomidine combined with esmolol on lung cancer patients and its effects on Toll-like receptor 4/ nuclear factor-κB (TLR4/NF-κB) signaling pathway.Methods Eighty patients with lung cancer whounderwent radical surgery of lung cancer in Panzhihua Second People′s Hospital from October 2017 to December 2018 were retrospectively selected as the research subjects, and the patients were assigned into the control group and the combination group according todifferent treatment methods, with 40 patients in each group. Patients in the control group were treated with dexmedetomidine, and patients in the combination group were treated with esmolol hydrochloride on the basis of the treatment adopted in the control group. ELISA method was used to detect the levels of interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor-α (TNF-α) at pre-operation (T1), after thoracotomy (T2), one-lung ventilation for 60 minutes (T3), and at the end of operation (T4), respectively. ELISA method was used to detect the levels of malondialdehyde (MDA), myeloperoxidase (MPO) and xanthine oxidase (XOD). arterial partial pressureof oxygen (PaO2), oxygenation index (OI), airway plateau pressure (APP), airway resistance, and the number of polymorphonuclear leukocytes (PMN) were detected. Real-time fluorescence quantitative reverse transcription polymerase chain reaction (qRT-PCR) was used to detect the expressions of TLR4 and NF-κB mRNA.Results The interaction of medication and time had statistically different effects on IL-6, IL-8, TNF-α, MDA, MPO, XOD, PaO2, OI, APP, AR, and the number of PMN (P<0.05). In the combination group, there were significantly lower levels of IL-6 [(16.52±2.32)/(30.20±6.21)/(33.21±5.31)ng/L vs. (29.63±8.52)/(42.36±10.19)/(55.41±6.85)pg], IL-8 [(9.62±1.03)/(11.52±2.11)/(18.24±1.54)ng/L vs. (13.52±1.41)/(18.67±3.21)/(30.21±3.52)ng/L], TNF-α [(10.21±1.21)/(20.31±1.42)/ (30.19±2.46)ng/L] vs. [(15.42±3.32)/(39.47±6.21)/(45.41±6.16)ng/L], MDA [(5.63 ±0.22)/(5.72±0.21)/(6.32±0.33)mmol/L vs. (10.32± 1.03)/(12.31±1.01)/(15.62±1.12)mmol/L], MPO [(6.35±1.02)/(7.31 ±1.12)/(6.30±1.08)μg/L vs. (8.35±1.13)/(11.21±1.30)/(12.13±0.56) μg/L], XOD [(5.61±0.85)/(5.14±0.26)/(4.21±0.13)μg/L vs. (7.61±1.10)/(8.64±1.32)/(10.51±2.21)μg/L], APP [(18.62±2.13)/(16.62± 1.32)/(13.25±1.13)cmH2O vs. (22.31 ±3.24)/(22.96±2.18)/(15.32±1.02)cmH2O], AR [(15.62±1.10)/(14.33±1.12)/(13.20±1.01)cmH2O/LS vs. (17.92±1.16)/(16.34±1.05 )/(15.39±0.25)cmH2O/LS], PMN [(6.33±0.15)/(8.13±0.49)/(10.13±0.32) ×109/L vs. (8.22±1.56)/(12.42± 1.55)/(13.52± 0.62)×109/L] than the control group (P<0.05), and there were significantly higher levels of PaO2[(83.16±1.02)/(93.21± 3.11)/(96.31±1.24)mmHg vs. (80.21±1.33)/(82.31±5.21)/(90.32±1.30)mmHg], OI [(287.42±16.24)/(316.24±14.25)/(359.47±15.64) mmHg vs. (222.31±15.67)/(286.51± 14.52)/(312.31±11.27)mmHg] was significantly higher than the control group (P<0.05). The interaction of medication and time had statistically significant effects on the expressions of TLR4 and NF-κB mRNA (P<0.05). In the combination group the expressions of TLR4 mRNA [(0.946±0.016)/(0.924±0.017)/(0.351±0.010) vs. (0.983±0.021)/(0.985±0.017)/(0.679± 0.014)] at T2, T3, and T4 time points and the expressions of NF-κB mRNA [(0.940±0.092)/(0.300±0.046) vs. (0.979±0.115)/(0.731± 0.135)] at T3 and T4 time points were significantly lower than those of the control group (all P<0.05).Conclusion Medetomidine combined with esmolol hydrochloride can effectively protect lung function and reduce inflammation and oxidative stress in patients undergoing radical lung cancer surgery, which may play a role by inhibiting the TLR4/NF-κB signaling pathway.
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