Sun Daqi, Li Kunyue, Chai Ziqi, Wang Lijuan, Gu Shimin, Sun Na, Zhang Yu, Wang Yuxia, Wang Tao
Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
J Res Med Sci. 2024 Feb 23;28:86. doi: 10.4103/jrms.jrms_336_23. eCollection 2023.
Breast cancer is one of the most common cancers in women. General anesthesia is a commonly used anesthesia method for breast cancer surgery, and studies have confirmed that general anesthesia can induce immunosuppression in breast cancer patients and increase the metastasis rate of tumors. However, the difference between the effects of intravenous general anesthesia and inhalation anesthesia on the function of T-lymphocytes is still controversial, and it is necessary to explore reasonable anesthesia methods to reduce immunosuppression caused by surgery and anesthesia.
Databases (Embase, PubMed, Cochrane Library, CBM, CNKI, and Wanfang) were searched (up to October 2022) for randomized controlled trials (RCTs) comparing intraoperative inhalation anesthesia and propofol intravenous anesthesia in breast cancer patients, with the outcome of T-lymphocyte subsets. The meta-analysis was performed by STATA 14.0.
Six RCTs with 352 patients were included in the study. Compared with inhalation anesthesia, there was no difference in T-lymphocyte subsets between the two groups immediately after surgery, but the activities of CD4 T cells in patients with propofol anesthesia were higher (standard mean difference [SMD] = 0.234, 95% confidence interval [CI]: 0.003-0.466, = 0.047, = 44.1%) than those under inhalation anesthesia 1 day after surgery, and CD4/CD8 activities in patients with propofol anesthesia were higher (SMD = 304, 95% CI: 0.072-0.537, = 0.010, = 48.0%) than those under inhalation anesthesia 1 day after surgery.
There were no differences in the effects of propofol and inhalation anesthetics on T-lymphocytes immediately after surgery, but the inhibitory effects of inhalation anesthetics on CD4 and CD4/CD8 cells were stronger 1 day after surgery.
乳腺癌是女性最常见的癌症之一。全身麻醉是乳腺癌手术常用的麻醉方法，研究证实全身麻醉可诱导乳腺癌患者免疫抑制并增加肿瘤转移率。然而，静脉全身麻醉和吸入麻醉对T淋巴细胞功能的影响差异仍存在争议，有必要探索合理的麻醉方法以减轻手术和麻醉引起的免疫抑制。
检索数据库（截至2022年10月）（Embase、PubMed、Cochrane图书馆、中国生物医学文献数据库、中国知网和万方），查找比较乳腺癌患者术中吸入麻醉和丙泊酚静脉麻醉并以T淋巴细胞亚群为结局指标的随机对照试验（RCT）。采用STATA 14.0进行荟萃分析。
本研究纳入6项RCT，共352例患者。与吸入麻醉相比，术后即刻两组T淋巴细胞亚群无差异，但丙泊酚麻醉患者术后1天CD4 T细胞活性高于吸入麻醉患者（标准化均数差[SMD]=0.234，95%置信区间[CI]：0.003 - 0.466，P = 0.047，I² = 44.1%），丙泊酚麻醉患者术后1天CD4/CD8活性高于吸入麻醉患者（SMD = 0.304，95% CI：0.072 - 0.537，P = 0.010，I² = 48.0%）。
丙泊酚和吸入麻醉药术后即刻对T淋巴细胞的影响无差异，但术后1天吸入麻醉药对CD4和CD4/CD8细胞的抑制作用更强。
