Effects Of Different Anesthesia And Analgesia On T Lymphocyte Subsets And The Differentiation Of T Helper Lymphocytes In The Esophageal Carcinoma Patients Undergoing Thoracic Surgery

Objective: To investigate the effects of different anesthesia and analgesia on T lymphocyte subsets and the differentiation of T helper lymphocytes in the esophageal carcinoma patients undergoing thoracic surgery, and to explore the possibility of corresponding mechanism.Methods: Sixty esophageal carcinoma patients, classified as ASA physical statusâ… -â…¡, scheduled for elective thoracic surgery were randomly divided into three groups with 20 cases each. In groupâ… , patients received general anesthesia(TIVA) and patient-controlled intravenous analgesia (PCIA) postoperatively; patients in groupâ…¡received general anesthesia combined with thoracic epidural anesthesia (CGEA) during surgery and the same method of analgesia as groupâ… postoperatively; In groupâ…¢patients were anesthetized as well as those in groupâ…¡, and received patient-controlled epidural analgesia(PCEA) postoperatively. Venous blood samples were taken before the induction of anesthesia(T0), 2h after incision(T1), 4h after the end of surgery (T2), 24h after the end of surgery (T3) and 48h after the end of surgery (T4). Pain intensity was assessed at T2, T3 and T4 with a box scale (0-10, where 0 is no pain and 10 is the worst pain ever) .The percentage of CD4⁺ T lymphocytes(CD4⁺), CD8⁺ T lymphocytes(CD8⁺), IFN-γ-producing T lymphocytes (Th₁) and IL-4-producing T lymphocytes (Th₂) were quantified by using flow cyto-metry. And the ratio of Th₁/Th₂ and CD4⁺/CD8⁺were calculated. Results: (1) Effects of analgesia The effects of postoperative pain control in all groups were satisfactory. However the VAS scores in groupâ…¡andâ…¢were significantly lower than in groupâ… at T2(P <0.05).And the VAS scores in groupâ…¢were significantly lower than in groupâ… andâ…¡at T3(P<0.05).(2)Changes of CD4⁺ and CD8⁺ T lymphocyte subsets The percentage of CD4⁺ and the CD4⁺/CD8⁺ ratios were similar before anesthesia among three groups. Compared with the values at T0, the percentage of CD4⁺ from T1 to T4 in groupâ… decreased significantly, as well as the CD4⁺/CD8⁺ ratios at T2 and T4 (P <0.05). The percentage of CD4⁺ and the CD4⁺/CD8⁺ ratios in groupâ…¡decreased significantly at T3 and T4 (P <0.05). However, the percentage of CD4⁺ and the CD4⁺/CD8⁺ ratios did not change over the period of the study in groupâ…¢. The percentage of CD4⁺ in groupâ…¡from T1 to T3 were significantly higher than those in groupâ… (P <0.05). Although the CD4⁺/CD8⁺ ratios in groupâ…¡increased significantly at T2 than that in groupâ… (P <0.05), there were no significant differences between groupâ… and groupâ…¡at any other postoperative time points (P> 0.05). The percentage of CD4⁺ and the CD4⁺/CD8⁺ ratios in groupâ…¢were significantly higher than those of groupâ…¡at T3 and T4 (P <0.05).(3)Changes of T helper lymphocytes(Th) The percentage of Th₁ and Th₂, the ratio of Th₁/Th₂ had no significant difference among three groups(P>0.05). The percentage of Th₁ in all groups from T2 to T4 decreased significantly (P<0.05). The ratio of Th₁/Th₂in groupâ… at T2 and T4, and that in groupâ…¡at T3 and T4 decreased significantly (P<0.05). The percentage of Th₂ in groupâ… and groupâ…¡from T2 to T4 were increased as well as that in groupâ…¢at T3(P<0.05). The ratio of Th₁/Th₂in groupâ…¡andâ…¢were higher than that in groupâ… at T2 (P<0.05). The ratio of Th₁/Th₂ in groupâ…¢were higher than those in groupâ…¡at T3 and T4(P<0.05).Conclusion: The immune function of patients with esophageal cancer after thoracic surgery has been further inhibited, such as CD4⁺ T lymphocytes in the lower percentage, decrease of the CD4⁺/CD8⁺ ratios or the balance of Th₁ and Th₂ felling to the Th₂ shift. These results suggested that general anesthesia combined with thoracic epidural anesthesia and PCEA may preserve the percentage of CD4⁺ T lymphocytes and the CD4⁺/CD8⁺ ratios in peripheral blood after operation, as well as inhibit the differentiation of precursor T helper cells (Th₀) into Th₂. Our data demonstrated that in the esophageal carcinoma patients undergoing thoracic surgery, general anesthesia combined with thoracic epidural anesthesia and PCEA is able to improve the cellular immune function.