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中华腔镜泌尿外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (05) : 396 -400. doi: 10.3877/cma.j.issn.1674-3253.2021.05.008

临床研究

高原地区术中低体温对非肌层浸润性膀胱癌患者术后免疫功能和远期复发的影响
杨红霞1,(), 龙喜花1, 罗朝霞1   
  1. 1. 810001 青海大学附属医院泌尿外科
  • 收稿日期:2021-01-26 出版日期:2021-10-01
  • 通信作者: 杨红霞
  • 基金资助:
    青海大学附属医院科学创新基金项目(FYXC-2017-04)

Effect of intraoperative hypothermia on postoperative immune function and long-term recurrence in patients with non-muscle invasion bladder cancer in plateau area

Hongxia Yang1,(), Xihua Long1, Zhaoxia Luo1   

  1. 1. Department of Urology, Qinghai University Affiliated Hospital, Qinghai 810001, China
  • Received:2021-01-26 Published:2021-10-01
  • Corresponding author: Hongxia Yang
引用本文:

杨红霞, 龙喜花, 罗朝霞. 高原地区术中低体温对非肌层浸润性膀胱癌患者术后免疫功能和远期复发的影响[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(05): 396-400.

Hongxia Yang, Xihua Long, Zhaoxia Luo. Effect of intraoperative hypothermia on postoperative immune function and long-term recurrence in patients with non-muscle invasion bladder cancer in plateau area[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(05): 396-400.

目的

探讨术中低体温对非肌层浸润性膀胱癌(NMIBC)患者术后免疫功能和远期复发的影响。

方法

试验设计属于前瞻性研究,以2015年1月至2019年12月期间符合条件的337例NMIBC患者为研究对象。根据术中最低体温36℃为界将患者分为低体温组和对照组。于麻醉诱导前1 h(T0)、手术结束时(T1)及术后24 h(T2)抽取外周静脉血检测Thl/Th2型细胞内细胞因子。长期随访以电话随访为主,失效事件为膀胱癌复发。

结果

337例参与者中,158例(46.9%)患者出现术中低体温。与对照组相比,低体温组T1时的IFN-γ水平和IFN-γ/IL-4显著降低,低体温组T2时的IFN-γ水平和IFN-γ/IL-4显著降低,而IL-4水平显著升高。对照组有102例出现膀胱癌复发,无复发生存时间为15(3~48)个月;低体温组有97例出现膀胱癌复发,无复发生存时间为12(3~60)个月,两组之间无复发生存曲线差异无统计学意义(χ2=0.533,P=0.465)。对于T1期患者,对照组有28例出现膀胱癌复发,无复发生存时间为10.5(3~48)个月;低体温组有36例出现膀胱癌复发,无复发生存时间为10.5(3~45)个月,两组之间的无复发生存曲线差异有统计学意义(χ2=5.261,P=0.022)。对于非T1期患者,对照组有74例出现膀胱癌复发,无复发生存时间为15(3~48)个月;低体温组有61例出现膀胱癌复发,无复发生存时间为12(3~60)个月,两组之间的无复发生存曲线差异无统计学意义(χ2 =0.199,P=0.656)。多因素Cox回归分析表明术中低体温是影响复发的独立危险因素之一[HR:1.153(1.055~3.984),P=0.039]。

结论

术中低体温能抑制NMIBC患者术后的细胞免疫功能,并且是T1期患者术后复发的危险因素之一,术中保温对于进一步改善NMIBC患者的预后具有一定的意义。

Objective

To explore the effect of intraoperative hypothermia on postoperative immune function and long-term recurrence in patients with non-muscle invasion bladder cancer (NMIBC).

Methods

This study was a prospective study which included 337 NMIBC patients meeting the conditions between January 2015, and December 2019. Patients were divided into hypothermia group and control group according to the lowest body temperature (36℃) during operation. Peripheral venous blood was taken to detect Thl/Th2 intracellular cytokines at 1 h before induction of anesthesia (T0), the end of surgery (T1) and 24 h after operation (T2). The main form of follow-up was telephone follow-up. Endpoint was bladder cancer recurrence.

Results

Of the 337 participants, 158 cases (46.9%) showed intraoperative hypothermia. Compared with the control group, the hypothermia group had a significantly lower level of IFN-γ and IFN-γ/IL-4 at T1, and a significantly lower level of IFN-γand IFN-γ/IL-4 and a significantly higher level of IL-4 at T2. In the control group, 102 patients had recurrence of bladder cancer, and the recurrence-free survival time was 15 (3-48) months. In the hypothermia group, 97 patients had bladder cancer recurrence, and the recurrence-free survival time was 12 (3-60) months. There was no significant difference in the recurrence-free survival curve between the 2 groups (χ2=0.533, P=0.465). For patients with T1, 28 patients had recurrence of bladder cancer, and the recurrence-free survival time was 10.5(3-48) months in the control group, 36 patients had recurrence of bladder cancer, and the recurrence-free survival time was 10.5(3-45)months in the hypothermia group. There was a significant difference in the recurrence-free survival curves between the 2 groups (χ2=5.261, P=0.022). For non-T1 patients, 74 patients had bladder cancer recurrence in the control group, and the recurrence-free survival time was 15(3-48) months. 61 patients had bladder cancer recurrence in the hypothermia group, and the recurrence-free survival time was 12(3-60) months. There was no significant difference in the recurrence-free survival curve between the 2 groups (χ2=0.199, P=0.656). Multivariate Cox regression analysis showed that intraoperative hypothermia was one of the independent risk factors for recurrence [HR:1.153(1.055-3.984), P=0.039].

Conclusions

Intraoperative hypothermia inhibits postoperative cellular immune function in patients with NMIBC is one of risk factors for postoperative recurrence in NMIBC patients with T1. Intraoperative warming has a certain significance for further improving the prognosis of patients with NMIBC.

表1 低体温组和对照组膀胱癌患者不同时点Thl/Th2型细胞比较[%(±s)]
图1 T1期膀胱癌患者低体温组和对照组的无复发生存曲线比较
表2 T1期膀胱癌患者复发组和无复发组的临床资料比较
表3 影响T1期非肌层浸润性膀胱癌患者复发的多因素Cox回归分析
[1]
陈晓芳, 陈万青, 周薇薇, 等. 2013年中国膀胱癌发病和死亡流行状况分析[J]. 中国肿瘤, 2018, 27(2): 81-85.
[2]
陈蓉, 许辉, 李辉章, 等. 2010~2014年浙江省肿瘤登记地区膀胱癌发病与死亡分析[J]. 中国肿瘤, 2019, 28(2): 115-119.
[3]
中国研究型医院学会泌尿外科学专业委员会, 中国医疗保健国际交流促进会泌尿健康促进分会, 中国医疗保健国际交流促进会循证医学分会, 等. 中国非肌层浸润性膀胱癌治疗与监测循证临床实践指南(2018简化版)[J]. 中国循证医学杂志, 2018, 18(12): 1267-1272.
[4]
Babjuk M, Böhle A, Burger M, et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2016[J]. Eur Urol, 2017, 71(3): 447-461.
[5]
张莲, 陈松, 张卫兵, 等. 高级别T1膀胱癌术后肿瘤复发与进展的相关影响因素[J]. 现代泌尿外科杂志, 2019, 24(11): 938-943.
[6]
刘秀丽, 廖华. 术中低体温对患儿机体影响的研究进展[J]. 医药前沿, 2018, 8(19): 8-9.
[7]
李莲英. 术中低体温对手术患者的影响及护理措施的研究进展[J]. 中国当代医药, 2018, 25(5): 25-27.
[8]
Yi J, Lei Y, Xu S, et al. Intraoperative hypothermia and its clinical outcomes in patients undergoing general anesthesia: national study in China[J]. PLoS One, 2017, 12(6): e0177221.
[9]
安磊. 低温环境对小鼠淋巴细胞亚群的影响及玉屏风散的调节作用[J]. 内蒙古中医药, 2017, 36(2): 130.
[10]
王炳卫, 杨国胜, 王镇伟, 等. 经尿道直出绿激光推铲式汽化切剜术对良性前列腺增生患者免疫功能的影响[J]. 中华腔镜泌尿外科杂志(电子版), 2020, 14(1): 21-25.
[11]
Hall BM, Geraci TC, Machan JT, et al. Lack of lymphocyte recovery after esophagectomy predicts overall and recurrence-free survival[J]. J Surg Res, 2020, 246(2): 379-383.
[12]
Becerra á, Valencia L, Ferrando C, et al. Prospective observational study of the effectiveness of prewarming on perioperative hypothermia in surgical patients submitted to spinal anesthesia[J]. Sci Rep, 2019, 9(1): 16477.
[13]
梁瑞晨, 杨昌美, 韩杰, 等. 泌尿外科腰麻微创手术患者术中低体温发生情况及其影响因素分析[J].护理学报, 2017, 24(24): 5-8.
[14]
Harihara Y, Nagata R, Den K, et al. Perioperative hypothermia and surgical site infection risk[J]. J Jpn Soc Surg Infect, 2015, 12(2): 279-285.
[15]
方茜, 王娟, 蒙婷婷, 等. 术中低体温对剖宫产产妇的临床影响[J]. 重庆医学, 2014, 43(27): 3677-3679.
[16]
赵力, 赵敏, 赵光瑜, 等. 浅低体温对肺癌根治术患者Th1/Th2型细胞因子的影响[J]. 中华麻醉学杂志, 2011, 31(9): 1151-1152.
[17]
Dobrodeeva LK, Samodova AV, Balashova SN. Cellular reactions in capillary and venous blood in northerners to a short-term period in a climatic chamber[J]. Immun Inflamm Dis, 2020, 8(3): 408-414.
[18]
Di Benedetto P, Ruscitti P, Vadasz Z, et al. Macrophages with regulatory functions, a possible new therapeutic perspective in autoimmune diseases[J]. Autoimmun Rev, 2019, 18(10): 102369.
[19]
菅金波, 张鲁燕, 宁方玲. Th17细胞在恶性肿瘤中作用的研究进展[J]. 滨州医学院学报, 2020, 43(3): 222-224, 228.
[20]
鞠小丽, 刘霞. 肿瘤细胞免疫原性死亡研究进展[J]. 南京医科大学学报(自然科学版), 2020, 40(7): 1070-1073.
[21]
Zhang YJ, Min Q, Huang Y, et al. Efficacy of acupuncture and moxibustion as a subsequent treatment after second-line chemotherapy in advanced gastric cancer[J]. Evid Based Complement Alternat Med, 2020, 2020,15 (4):1-9.
[22]
杨亮, 王丹琦, 曹越, 等. 2018年EAU非肌层浸润性膀胱癌的指南解读-辅助治疗(化学治疗与戒烟)篇[J]. 中国研究型医院, 2019, 6(1): 34-39.
[23]
邓通, 梁丹丹, 黄瑞秀, 等. 2018年EAU非肌层浸润性膀胱癌指南解读-诊断、复发与进展风险评估篇[J]. 中国研究型医院, 2018, 5(5): 44-49.
[24]
Morozumi K, Mitsuzuka K, Takai Y, et al. Intraoperative hypothermia is a significant prognostic predictor of radical cystectomy especially for stage II muscle-invasive bladder cancer[J]. Medicine (Baltimore), 2019, 98(2): e13962.
[25]
张帆, 邸泰霖, 韩克松. 外周血T淋巴细胞亚群水平对结直肠癌患者术后复发的影响及预测价值分析[J]. 中国内镜杂志, 2020, 26(11): 8-14.
[26]
金方方, 金子铮, 刘宁,等. 肝细胞肝癌复发前后CD3高表达T淋巴细胞的变化[J]. 检验医学, 2020, 35(3): 209-213.
[27]
Ukai R, Hashimoto K, Nakayama H, et al. Lymphovascular invasion predicts poor prognosis in high-grade pT1 bladder cancer patients who underwent transurethral resection in one piece[J]. Jpn J Clin Oncol, 2017, 47(5):447-452.
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