癌痛控制前后致痛物质的表达及免疫功能改变的临床意义

黄先达; 石围; 龚泉; 李仕娟; 张利娟; 周春艳; 陈曦; 庄莉; 王存德

doi:10.16766/j.cnki.issn.1674-4152.002315

癌痛控制前后致痛物质的表达及免疫功能改变的临床意义

doi: 10.16766/j.cnki.issn.1674-4152.002315

云南省肿瘤医院昆明医科大学第三附属医院姑息医学科云南省肿瘤姑息医学研究中心，云南昆明 650000

基金项目:

云南省医疗卫生单位内设研究机构科研项目 2016NS097

详细信息

通讯作者:
王存德, E-mail: wcd69@fxmail.com

中图分类号: R730.6 R730.3
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- 被引次数: 0
出版历程
- 收稿日期: 2021-05-11
- 网络出版日期: 2022-03-04

Clinical significance of the expression of algogenic substances and the change in immune function before and after control of cancer pain

Department of Palliative Medicine, Yunnan Tumor Hospital, the Third Affiliated Hospital of Kunming Medical University, Palliative Medicine Department of Yunnan Tumor Palliative Medicine Research Center, Kunming, Yunnan 650000, China

摘要

摘要: 目的探讨癌痛与致痛物质及免疫功能的关系，以期筛选出用于癌痛评估及疗效监测的敏感指标，并初步探寻致痛物质在癌痛中的作用机制。方法选取2016年1月—2019年1月在云南省肿瘤医院确诊的60例癌痛患者作为观察组，同时分别选取30例健康人群和30例无疼痛肿瘤患者作为对照组，采用酶联免疫吸附测定血浆中TNF-α、IL-6、β-内啡肽、神经生长因子(NGF)和溶血磷脂酸(LPA)的含量，应用流式细胞术检测癌痛控制前后患者外周血T淋巴细胞亚群的变化；统计分析致痛物质的表达与癌痛程度、爆发痛、远处转移等各因素的关系。结果观察组TNF-α、IL-6、β-内啡肽、NGF和LPA的含量均显著高于对照组。癌痛控制后血清TNF-α、IL-6、β-内啡肽、NGF的含量分别为(87.77±11.60)ng/L、(33.33±6.43)ng/mL、(24.00±5.93)ng/mL、(19.85±3.78)pg/mL，明显低于癌痛控制前水平[(220.20±32.11)ng/L、(59.48±10.26)ng/mL、(38.62±8.01)ng/mL、(34.32±6.21)pg/mL]，但LPA的表达在癌痛控制前后差异无统计学意义。TNF-α、IL-6、NGF和LPA的含量与癌痛程度、爆发痛、远处转移有关。β-内啡肽的表达水平与癌痛程度、远处转移有关。癌痛控制后CD3⁺、CD4⁺、CD4⁺/CD8⁺均显著高于癌痛控制前；而癌痛控制后CD8⁺却明显低于控制前。结论 TNF-α、IL-6、β-内啡肽、NGF和LPA在癌痛中可能起着一定作用，可辅助用于癌痛评估及疗效监测；癌痛可使机体免疫功能降低。
- 癌性疼痛 /
- 肿瘤坏死因子-α /
- 白介素-6 /
- β-内啡肽 /
- 神经生长因子 /
- 溶血磷脂酸
Abstract: Objective To explore the relationship between cancer pain and algogenic substances and immune function to screen out sensitive indicators for cancer-pain assessment and curative-effect monitoring, as well as to preliminary explore the role of algogenic substances in cancer pain. Methods A total of 60 patients with cancer pain diagnosed at the Yunnan Cancer Hospital from January 2016 to January 2019 were selected as the test group, and 30 healthy people and 30 patients with painless tumours were selected as the control group. Enzyme-linked immunosorbent assay was used to determine the levels of TNF-α, IL-6, β-endorphin, NGF, and LPA in plasma. Flow cytometry was used to detect the change in peripheral blood T lymphocyte subsets before and after cancer-pain control. The relationship of the expression of algogenic substances with the degree of cancer pain, outbreak pain, and distant metastasis was analysed statistically. Results The contents of TNF-α, IL-6, β-endorphin, NGF, and LPA in the experimental group were significantly higher than those in the control group. The levels of TNF-α, IL-6, β-endorphin, and NGF in serum after cancer-pain control were (87.77±11.60) ng/L, (33.33±6.43) ng/mL, (24.00±5.93) ng/mL, and (19.85±3.78) pg/mL, respectively. It was significantly lower than the level before cancer-pain control [(220.20±32.11) ng/L, (59.48±10.26) ng/mL, (38.62±8.01) ng/mL, (34.32±6.21) pg/mL], but no significant difference existed in LPA expression before and after cancer-pain control. The contents of TNF-α, IL-6, NGF, and LPA were related to the degree of cancer pain, outbreak pain, and distant metastasis. The expression level of β-endorphin was related to the degree of cancer pain and distant metastasis. The percentages of CD3⁺, CD4⁺, and CD4⁺/CD8⁺ after cancer pain control were significantly higher than those before cancer-pain control, but the percentage of CD8⁺ after cancer pain control was significantly lower than before cancer pain control, and the difference was statistically significant. Conclusion TNF-α, IL-6, β-endorphin, NGF, and LPA may play certain roles in cancer pain, which can be used to evaluate cancer pain and monitor therapeutic effect. Cancer pain can reduce the body's immune function.
- Cancer pain /
- Tumour necrosis factor alpha /
- Interleukin-6 /
- Beta-endorphin /
- Nerve growth factor /
- Lysophosphatidic acid

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表 1 3组各致痛物质比较(x ±s)

组别	例数	TNF-α(ng/L)	IL-6(ng/mL)	β-内啡肽(ng/mL)	NGF(pg/mL)	LPA(μmol/L)
观察组	60	220.20±32.11^ab	59.48±10.26^ab	38.62±8.02^ab	34.32±6.22^ab	4.21±0.93^ab
无痛对照组	30	72.73±10.58	23.40±3.60	20.67±5.18	17.33±4.12	3.34±0.58
健康对照组	30	53.73±12.42	24.40±5.64	17.00±4.40	16.93±3.11	3.07±0.50
F值		635.858	296.347	136.170	169.861	26.567
P值		< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
注：与无痛对照组比较, ^aP < 0.05；与健康对照组比较, ^bP < 0.05。

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表 2 癌痛患者癌痛控制前后各致痛物质比较(x ±s)

时间	例数	TNF-α(ng/L)	IL-6(ng/mL)	β-内啡肽(ng/mL)	NGF(pg/mL)	LPA(μmol/L)
癌痛控制前	60	220.20±32.11	59.48±10.26	38.62±8.01	34.32±6.21	4.21±0.93
癌痛控制后	60	87.77±11.60	33.33±6.43	24.00±5.93	19.85±3.78	4.11±0.93
t值		44.883	32.249	25.800	21.019	1.528
P值		< 0.001	< 0.001	< 0.001	< 0.001	0.132

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表 3 TNF-α、IL-6、β-内啡肽、NGF、LPA的水平与各临床因素的关系(x ±s)

因素	类别	例数	TNF-α(ng/L)	IL-6(ng/mL)	β-内啡肽(ng/mL)	NGF(pg/mL)	LPA(μmol/L)
性别	女性	21	220.76±27.99	60.91±9.85	39.77±8.47	35.00±6.01	4.00±0.80
	男性	39	219.90±34.47	58.72±10.51	37.95±7.77	33.95±6.37	4.32±0.99
t值			-0.099	-0.785	0.848	-0.622	1.268
P值			0.922	0.435	0.400	0.537	0.210
年龄(岁)	≥60	28	225.15±31.39	60.57±11.35	39.11±8.34	34.46±6.90	4.23±0.88
	< 60	32	216.41±32.60	58.53±9.27	38.19±7.83	34.19±5.66	4.19±0.99
t值			-1.046	-0.766	0.440	-0.171	-0.169
P值			0.300	0.447	0.661	0.865	0.866
癌痛程度(分)	≥4	35	230.29±26.74	64.14±7.83	41.54±6.62	37.11±5.01	4.69±0.75
	< 4	25	206.08±34.14	52.96±9.79	34.52±8.12	30.40±5.66	3.54±0.73
t值			3.079	4.914	3.686	4.849	5.922
P值			0.003	< 0.001	0.001	< 0.001	< 0.001
爆发痛	有	26	232.25±26.42	63.85±9.44	40.85±7.61	37.85±4.10	4.89±0.74
	无	34	212.17±33.37	56.15±9.70	36.91±8.00	31.62±6.25	3.69±0.70
t值			2.474	-3.082	-1.927	-4.651	-6.440
P值			0.016	0.003	0.059	< 0.001	< 0.001
远处转移	有	24	240.16±18.83	64.46±7.93	42.96±6.17	37.58±4.33	4.73±0.78
	无	36	206.92±32.42	56.17±10.37	35.72±7.86	32.14±6.37	3.86±0.86
t值			-4.527	-3.318	-3.795	-3.940	-4.008
P值			< 0.001	0.002	< 0.001	< 0.001	< 0.001

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表 4 癌痛患者癌痛控制前后细胞免疫功能的变化(x ±s)

组别	例数	CD3⁺(%)	CD4⁺(%)	CD8⁺(%)	CD4⁺/CD8⁺
癌痛控制前	60	63.24±1.20	33.78±1.25	24.00±1.32	1.44±0.12
癌痛控制后	60	68.55±1.72	40.12±1.46	19.24±1.23	1.95±0.15
t值		-34.136	-51.455	55.220	-47.651
P值		< 0.001	< 0.001	< 0.001	< 0.001

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