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中华肺部疾病杂志(电子版) ›› 2021, Vol. 14 ›› Issue (01) : 53 -57. doi: 10.3877/cma.j.issn.1674-6902.2021.01.010

论著

氟比洛芬酯对肺癌围手术期患者氧化应激及血清VCAM-1、IMA的影响
邱壮光1, 韦雪梅1, 唐瑜2, 徐志新1,†()   
  1. 1. 570311　海口，海南医学院第二附属医院麻醉科
    2. 570311　海口，海南省海口市第四人民医院护理部
  • 收稿日期:2020-08-23 出版日期:2021-02-25
  • 通信作者: 徐志新

Effects of flurbiprofen axetil on oxidative stress and serum VCAM-1, IMA in patients with lung cancer during perioperative period

Zhuangguang Qiu1, Xuemei Wei1, Yu Tang2, Zhixin Xu1,†()   

  1. 1. Department of Anesthesiology, The Second Affiliated Hospital of Hainan Medical University, Haikou 570311, China
    2. Nursing Department, the Fourth People′s Hospital of Haikou City, Hainan Province, Haikou 570311, China
  • Received:2020-08-23 Published:2021-02-25
  • Corresponding author: Zhixin Xu
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引用本文：

邱壮光, 韦雪梅, 唐瑜, 徐志新. 氟比洛芬酯对肺癌围手术期患者氧化应激及血清VCAM-1、IMA的影响[J]. 中华肺部疾病杂志(电子版), 2021, 14(01): 53-57.

Zhuangguang Qiu, Xuemei Wei, Yu Tang, Zhixin Xu. Effects of flurbiprofen axetil on oxidative stress and serum VCAM-1, IMA in patients with lung cancer during perioperative period[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2021, 14(01): 53-57.

目的

探讨氟比洛芬酯对肺癌围手术期患者氧化应激及血清VCAM-1、IMA的影响。

方法

选择2017年3月至2019年9月我院收治的预进行肺癌根治术的76例肺癌患者，随机分为两组，研究组39例，对照组37例。对照组患者采用咪达唑仑进行麻醉诱导和麻醉维持，研究组给予氟比洛芬酯进行麻醉诱导和麻醉维持。分别在麻醉手术前(T0)、手术开始2 h(T1)、手术结束24 h(T2)时，采用酶联免疫吸附法(ELISA)测定患者血清中谷胱甘肽过氧化物酶(GSH-PX)、超氧化物歧化酶(SOD)、丙二醛(MDA)、过氧化氢(H2O2)、羟自由基(OH)、超氧阴离子()、血管细胞黏附分子-1(VCAM-1)和缺血修饰白蛋白(IMA)含量；测定患者血BUN、血Cr、尿β2微球蛋白/Cr比值和尿NAG/Cr比值；采用流式细胞技术测定患者血中Treg及IL-10水平。

结果

与T0时相比，T1和T2时，两组患者GSH-PX和SOD水平均下降(P<0.05)；MDA、H2O2、OH和水平均升高，且同一时间研究组患者上述参数降低或升高幅度明显低于对照组(P<0.05)；与T0时相比，T1和T2时，两组患者外周血中VCAM-1水平下降，且同一时间研究组患者VCAM-1水平明显低于对照组(P<0.05)；两组患者外周血中IMA水平升高，且同一时间研究组患者IMA升高幅度明显低于对照组(P<0.05)；两组患者血BUN、血Cr、尿β2微球蛋白/Cr比值和尿NAG/Cr比值均升高，研究组升高幅度明显低于对照组(P<0.05)；两组患者Treg和IL-10水平均降低，研究组明显高于对照组(P<0.05)。

结论

氟比洛芬酯可以有效抗击肺癌围手术期患者氧化应激，能有效降低患者血清中VCAM-1水平，有效控制IMA水平的升高，降低肺损伤，有效缓解手术引起的免疫反应，且具有良好的肾保护作用。

关键词: 氟比洛芬酯, 支气管肺癌, 氧化应激, 血管细胞黏附分子-1, 缺血修饰白蛋白
Objective

To study the effects of flurbiprofen axetil on oxidative stress and serum VCAM-1, IMA in patients with lung cancer during perioperative period.

Methods

76 patients with lung cancer treated in our hospital from March 2017 to September 2019 were randomly divided into study group (39 cases) and control group (37 cases). in the control group, midazolam was used for anesthesia induction and maintenance, and flurbiprofen axetil was given for anesthesia induction and maintenance in the study group. Before operation(T0), 2 h after the beginning of operation(T1) and 24 h after the completion of operation(T2), the contents of glutathione peroxidase (GSH-PX), superoxide dismutase(SOD), malondialdehyde (MDA), hydrogen peroxide(H2O2), hydroxyl radical(OH), superoxide anion(), vascular cell adhesion molecule-1(VCAM-1) and ischemia-modified albumin (IMA) were determined by enzyme-linked immunosorbent assay. The serum BUN, serum Cr, the ratio of urine β2 microglobulin/Cr and urine NAG/Cr were determined; The blood Treg and IL-10 levels were measured by flow cytometry.

Results

Compared to T0, the GSH-PX and SOD levels of the two groups decreased (P<0.05), the MDA, H2O2, OH and levels increased at T1 and T2, and the decrease or increase of above parameters were significantly lower in the study group at the same time than in the control group (P<0.05); Compared to T0, the VCAM-1 level of peripheral blood in the two groups decreased at T1 and T2, and the VCAM-1 level of the patients in the study group was significantly lower than that in the control group (P<0.05); The level of peripheral blood IMA in the two groups increased, and the IMA of the study group was significantly lower than that in the control group at the same time (P<0.05). The serum BUN, serum Cr, the ratio of urine β2 microglobulin/Cr and urine NAG/Cr increased in both groups, and the increase of study group was significantly lower than that of control group (P<0.05); The Treg and IL-10 levels of the two groups were decreased, and the study group was significantly higher than that of the control group (P<0.05).

Conclusion

Flurbiprofen axetil can effectively resist oxidative stress in patients with lung cancer during perioperative period, reduce the VCAM-1 level in serum, control the increase of IMA level, and reduce lung injury, and it can also effectively alleviate the immune response caused by surgery and has good renal protection effect.

Key words: Flurbiprofen axetil, Bronchogenic carcinoma, Oxidative stress, Vascular cell adhesion molecule-1, Ischemia modifies albumin
表1 两组患者手术前后氧化应激参数水平变化情况比较(±s)
参　数 组别 例数 T0 T1 T2
GSH-Px(U/ml) 研究组 39 36.56±6.84 25.37±4.78 36.46±6.39
  对照组 37 36.47±6.58 18.96±5.28 25.03±3.92
  t值   0.062 5.092 9.998
  P值   0.951 <0.001 <0.001
SOD(U/ml) 研究组 39 45.65±5.72 37.03±5.37 44.24±4.09
  对照组 37 45.19±5.82 30.27±6.22 35.23±4.27
  t值   0.370 5.394 9.992
  P值   0.713 <0.001 <0.001
MDA(nmol/L) 研究组 39 5.05±0.69 7.78±1.49 5.02±0.44
  对照组 37 5.03±0.77 9.53±1.47 6.57±0.36
  t值   0.133 5.483 7.878
  P值   0.894 <0.001 <0.001
H2O2(mmol/L) 研究组 39 34.66±6.04 55.34±7.65 34.48±4.09
  对照组 37 34.26±6.37 76.98±8.85 39.45±5.34
  t值   0.229 12.130 4.845
  P值   0.766 <0.001 <0.001
OH(U/ml) 对照组 39 341.23±59.23 415.23±55.45 356.37±38.64
  研究组 37 340.99±58.34 568.22±54.34 384.23±40.63
  t值   0.019 12.922 3.258
  P值   0.985 <0.001 0.002
(U/L) 对照组 39 110.96±16.43 157.35±23.43 113.36±31.78
  研究组 37 111.03±17.66 177.56±22.46 133.87±33.46
  t值   0.019 4.083 2.914
  P值   0.985 <0.001 0.005
表2 两组患者手术前后外周血VCAM-1和IMA水平变化情况比较(±s)
参　数 组别 例数 T0 T1 T2
VCAM-1(ng/ml) 研究组 39 264±21 251±18 241±20
  对照组 37 263±22 260±23 250±21
  t值   0.216 2.021 2.035
  P值   0.830 0.046 0.045
IMA(ng/ml) 对照组 39 11.56±3.65 14.36±4.26 16.89±6.33
  研究组 37 11.87±2.36 17.15±4.76 21.39±6.35
  t值   0.438 2.864 3.219
  P值   0.662 0.005 0.001
表3 两组患者手术前后肝功能相关参数水平情况比较(±s)
参　数 组别 例数 T0 T1 T2
血Cr(μmol/L) 研究组 39 63.19±11.00 82.87±15.74 64.26±14.73
  对照组 37 63.27±10.99 105.03±17.36 88.46±14.57
  t值   0.034 6.201 7.659
  P值   0.973 <0.001 <0.001
尿β2-MG/Cr(mg/mmol) 研究组 39 0.0161±0．0023 0.2765±0．0156 0.1027±0．0563
  对照组 37 0.0160±0．0022 0.5166±0．0203 0.1748±0．0746
  t值   0.206 54.842 5.059
  P值   0.837 <0.001 <0.001
尿NAG/Cr(U/mmol) 研究组 39 0.02461±0．0141 0.1526±0．0114 0.0269±0．0174
  对照组 37 0.02467±0．0134 0.2417±0．0153 0.0463±0．0142
  t值   0.020 30.622 5.664
  P值   0.984 <0.001 <0.001
血BUN(mmol/L) 研究组 39 4.82±0.62 11.35±1.87 8.17±2.31
  对照组 37 4.78±0.65 13.46±1.76 10.47±2.37
  t值   0.292 5.388 4.557
  P值   0.771 <0.001 <0.001
表4 两组患者手术前后Treg及其胞内细胞因子水平变化情况比较(±s)
项　目 组别 例数 T0 T1 T2
IL-10 研究组 39 6.27±0.91 5.11±0.45 4.19±0.23
  对照组 37 6.33±0.97 4.21±0.48 2.64±0.22
  t值   0.296 8.970 31.935
  P值   0.768 <0.001 <0.001
Treg 研究组 39 8.57±0.86 7.31±1.21 6.18±1.09
  对照组 37 8.64±0.77 5.66±1.02 4.47±1.02
  t值   0.398 6.837 7.511
  P值   0.692 <0.001 <0.001
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