乌司他丁对食管癌手术患者CD14+肺泡巨噬细胞及免疫功能的影响

目的:探讨术前静脉输注乌司他丁对食管癌手术患者单肺通气时CD14+肺泡巨噬细胞、局部及全身炎性反应和免疫功能的影响。方法:前瞻性选取南京医科大学附属肿瘤医院2019年10月至2020年8月行胸腔镜下食管癌根治手术患者80例，数字随机表法分为两组:对照组和乌司他丁组各40例。乌司他丁组患者麻醉诱导前静脉输注20 KU乌司他丁，对照组给予生理盐水。检测两组患者术前和术后2 h外周静脉中血白介素-2（IL-2）和免疫细胞，并检测术中单肺通气1 h后非通气侧肺支气管肺泡灌洗液（bronchoalveolar lavage fluid，BALF）中CD14+巨噬细胞、IL-2、免疫细胞。结果:两组患者一般情况比较无差异。术后2 h乌司他丁组患者外周血中IL-2、CD14+单核细胞增高幅度小于对照组，差异有统计学意义（P＜0.05），NK细胞、CD4+T细胞、CD8+T细胞及活化的T细胞亚群增高幅度高于对照组，差异有统计学意义（P＜0.05）。两组患者术前外周血IL-2、CD14+单核细胞及主要免疫细胞亚群差异无统计学意义（P>0.05）。与对照组相比，乌司他丁组患者单肺通气1 h后非通气侧肺BALF中IL-2和CD14+巨噬细胞增高幅度明显小于对照组，差异有统计学意义（P＜0.05），而CD4+T细胞、CD8+T细胞高于对照组，差异有统计学意义（P＜0.05），活化的T细胞也高于对照组，差异有统计学意义（P＜0.01）。结论:麻醉前给予乌司他丁能减少食管癌术中单肺通气时全身及肺部的炎性反应，保护患者的免疫功能，具有临床应用价值。

Effect of ulinastatin on CD14+alveolar macrophage and immune function in patients with esophageal cancer surgery

Objective:To investigate the effect of intravenous ulinastatin on CD14+alveolar macrophages,local and systemic inflammatory response,and immune function during one-lung ventilation in patients undergoing esophageal cancer surgery.Methods:Eighty patients who underwent thoracoscopic radical resection surgery of esophageal cancer were prospectively selected from October 2019 to August 2020 in the Affiliated Cancer Hospital of Nanjing Medical University.They were randomly divided into two groups using a digital random table method:The control group and the ulinastatin group,with 40 patients each.Before anesthesia induction,patients in the ulinastatin group received an intravenous infusion of 20 KU ulinastatin,while patients in the control group were given normal saline.Interleukin-2 (IL-2) and immune cells were detected in peripheral venous blood before operation and at 2 h after the operation,and CD14+macrophages,IL-2,and immune cells were detected in bronchoalveolar lavage fluid (BALF) on the non-ventilated side of the lung after one-lung ventilation about 1 h during operation.Results:There were no differences in general condition between the two groups.The increase of IL-2 and CD14+monocytes in the peripheral blood of patients in the ulinastatin group after the operation about 2 h was less than that of the control group (P＜0.05),and the increase of NK cells,CD4+T cells,CD8+T cells and activated T cell subsets was higher than that of the control group (P＜0.05).There was no difference between the two groups in peripheral blood IL-2,CD14+monocytes,and significant immune cell subsets before operation (P>0.05).Compared with the control group,the increase of IL-2 and CD14+macrophages in the lung BALF on the non-ventilated side of patients in the ulinastatin group was significantly lower than that in the control group (P＜0.05) after one-lung ventilation about 1 h.At the same time,CD4+T cells and CD8+T cells were higher than those in the control group (P＜0.05),and activated T cells were also higher than those in the control group (P＜0.01).Conclusion:The administration of ulinastatin before anesthesia can reduce the local and systemic inflammatory reaction,and protect the immune function of patients in one-lung ventilation during esophageal cancer surgery,which has clinical application value.