Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia.
Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia.
Br J Clin Pharmacol. 2022 Jul;88(7):3114-3131. doi: 10.1111/bcp.15281. Epub 2022 Mar 1.
Understanding how pharmaceutical opioids and antipyretic analgesics interact with the immune system potentially has major clinical implications for management of patients with infectious diseases and surgical and critical care patients. An electronic search was carried out on MEDLINE, EMBASE, PsycINFO, CENTRAL and the Cochrane library to identify reports describing the immunomodulatory effects of opioid analgesics and antipyretic analgesics, and their effects in infectious diseases. In adaptive immunity, nonsteroidal anti-inflammatory drugs have divergent effects: augmenting cell-mediated immunity but inhibiting humoral immunity. Nonsteroidal anti-inflammatory drugs have demonstrated a beneficial role in Mycobacterium tuberculosis infection and histoplasmosis in animals, and may be plausible adjuvants to antimicrobial agents in these diseases. There is a need to evaluate these findings rigorously in human clinical trials. There is preliminary evidence demonstrating antiviral effects of indomethacin in SARS CoV-2 in vitro; however, uncertainty regarding its clinical benefit in humans needs to be resolved in large clinical trials. Certain opioid analgesics are associated with immunosuppressive effects, with a developing understanding that fentanyl, morphine, methadone and buprenorphine suppress innate immunity, whilst having diverse effects on adaptive immunity. Morphine suppresses key cells of the innate immunity and is associated with greater risk of infection in the postsurgical setting. Efforts are needed to achieve adequate analgesia whilst avoiding suppression of the innate immunity in the immediate postoperative period caused by certain opioids, particularly in cancer surgery.
了解药物阿片类药物和退热镇痛剂如何与免疫系统相互作用，对于管理传染病患者、外科和重症监护患者具有重要的临床意义。我们在 MEDLINE、EMBASE、PsycINFO、CENTRAL 和 Cochrane 图书馆进行了电子检索，以确定描述阿片类镇痛药和退热镇痛药免疫调节作用及其在传染病中作用的报告。在适应性免疫中，非甾体抗炎药具有不同的作用：增强细胞介导的免疫，但抑制体液免疫。非甾体抗炎药已在动物的结核分枝杆菌感染和组织胞浆菌病中显示出有益作用，并且可能是这些疾病中抗菌药物的合理佐剂。需要在人体临床试验中严格评估这些发现。有初步证据表明吲哚美辛在 SARS CoV-2 中有抗病毒作用；然而，需要在大型临床试验中解决其在人类中的临床获益的不确定性。某些阿片类镇痛药与免疫抑制作用有关，目前人们越来越了解芬太尼、吗啡、美沙酮和丁丙诺啡抑制先天免疫，而对适应性免疫有多种影响。吗啡抑制先天免疫的关键细胞，与术后感染风险增加有关。需要努力在术后即刻避免某些阿片类药物引起的先天免疫抑制的同时实现足够的镇痛，尤其是在癌症手术中。
