中性粒细胞与淋巴细胞比值作为胸腔镜手术后阿片类药物诱导免疫抑制的指标：一项随机对照试验

Neutrophil-to-Lymphocyte Ratio as an Indicator of Opioid-Induced Immunosuppression After Thoracoscopic Surgery: A Randomized Controlled Trial.

作者信息

Chen Qi, Liang Jingqiu, Liang Ling, Liao Zhongli, Yang Bin, Qi Jun

机构信息

Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, People's Republic of China.

Chongqing Cancer Multi-Omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, People's Republic of China.

出版信息

J Pain Res. 2022 Jun 30;15:1855-1862. doi: 10.2147/JPR.S371022. eCollection 2022.

DOI:10.2147/JPR.S371022

PMID:35795100

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9252298/

Abstract

PURPOSE

The neutrophil-to-lymphocyte ratio (NLR) is a useful prognostic marker for various diseases and surgery-induced immunosuppression. While opioids are important in general anesthesia, the association between immediate perioperative immune monitoring and opioid consumption for postoperative analgesia after video-assisted thoracoscopic surgery (VATS) is unknown. We aimed to investigate the effect of analgesic techniques on opioid-induced immune perturbation, and the feasibility of NLR as an indicator of opioid-induced immune changes.

PATIENTS AND METHODS

Patients were randomly assigned to two groups: Group P (n=40) or Group C (n=40). Patients in group P received ultrasound-guided paravertebral block (PVB) before surgery, and followed by sufentanil patient-controlled intravenous analgesia (PCIA) after surgery, and group C received sufentanil PCIA only. The total and differential white blood cell counts, including CD4+ T lymphocyte counts, CD8+ T lymphocyte were recorded before surgery and at 24 and 72 hours after surgery. NLR was determined using the frequencies of lymphocyte subpopulations. The cumulative dose of sufentanil were recorded at 24 and 24h after surgery while the 40-item quality of recovery questionnaire (QoR-40) score were assessed at 48h after the surgery.

RESULTS

At 24 and 48 hours after surgery, a lower sufentanil consumption, and higher QoR-40 recovery scores were found in group P than in group C (P<0.05). In biochemical analyses, the values of NLR were lower in group P compared to group C (<0.0001) and ratio of CD4/CD8 were higher in group P compared to group C (<0.05) on day three after surgery. NLR showed excellent predictive capability for immunosuppression, with an area under the curve (AUC) of 0.92 [95% confidence interval (CI), 0.86-0.98, P < 0.0001].

CONCLUSION

Opioid-sparing pain management strategies may affect postoperative immunosuppression and NLR could be a reliable indicator of opioid-related immunosuppression. Moreover, opioid-sparing pain management strategies could improve patient's satisfaction in VATS.

摘要

目的

中性粒细胞与淋巴细胞比值（NLR）是多种疾病和手术诱导免疫抑制的有用预后标志物。虽然阿片类药物在全身麻醉中很重要，但电视辅助胸腔镜手术（VATS）后围手术期即时免疫监测与术后镇痛阿片类药物消耗之间的关联尚不清楚。我们旨在研究镇痛技术对阿片类药物诱导的免疫扰动的影响，以及NLR作为阿片类药物诱导免疫变化指标的可行性。

患者与方法

患者随机分为两组：P组（n = 40）和C组（n = 40）。P组患者在手术前接受超声引导下椎旁阻滞（PVB），术后接受舒芬太尼患者自控静脉镇痛（PCIA），C组仅接受舒芬太尼PCIA。记录手术前、术后24小时和72小时的白细胞总数和分类计数，包括CD4 + T淋巴细胞计数、CD8 + T淋巴细胞计数。使用淋巴细胞亚群频率测定NLR。记录术后24小时和72小时舒芬太尼的累积剂量，同时在术后48小时评估40项恢复质量问卷（QoR - 40）评分。

结果

术后24小时和48小时，P组舒芬太尼消耗量低于C组，QoR - 40恢复评分高于C组（P < 0.05）。生化分析显示，术后第三天P组NLR值低于C组（< 0.0001），P组CD4/CD8比值高于C组（< 0.05）。NLR对免疫抑制具有出色的预测能力，曲线下面积（AUC）为0.92 [95%置信区间（CI），0.86 - 0.98，P < 0.0001]。