腹腔镜胆囊切除术前患者血清IL-1β、IL-6、TNF-α水平与瑞芬太尼所致痛觉过敏的相关性

Correlation between serum levels of IL-1β, IL-6, TNF-α, and hyperalgesia induced by remifentanil before laparoscopic cholecystectomy

摘要:

目的 观察腹腔镜胆囊切除术瑞芬太尼所致痛觉过敏患者血清白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）表达情况，并分析各血清指标与痛觉过敏的关系，指导早期预测与干预。方法 选取2017年4月—2019年11月绵阳市中心医院230例接受腹腔镜胆囊切除术治疗的患者，依据术后是否发生瑞芬太尼所致痛觉过敏将入选者分为发生组与未发生组。检测并比较两组患者术前血清IL-1β、IL-6、TNF-α水平；分析血清各指标之间及其与瑞芬太尼所致痛觉过敏的相关性；绘制受试者工作特征（ROC）曲线；影响因素的分析用多因素Logistic回归模型。结果 230例腹腔镜胆囊切除术患者中，发生瑞芬太尼所致痛觉过敏的患者81例（35.22%）。发生组血清IL-1β、IL-6、TNF-α水平高于未发生组（P <0.05）。双变量Pearson直线相关性检验结果显示，腹腔镜胆囊切除术患者血清IL-1β与IL-6、TNF-α呈正相关（r =0.521和0.567，均P <0.05），IL-6与TNF-α呈正相关（r =0.474，P <0.05）。Logistic回归分析结果显示，血清IL-1β［O^R=1.345（95% CI：1.012，1.943）］、IL-6［O^R=1.782（95% CI：1.369，1.991）］、TNF-α［O^R=1.593（95% CI：1.325，1.992）］是腹腔镜胆囊切除术患者发生瑞芬太尼所致痛觉过敏的影响因素（P <0.05）。ROC曲线显示：IL-1β截断值为23.156 pg/mL，AUC为0.835（95% CI：0.773，0.897），特异性为96.3%（95% CI：0.841，0.987），敏感性为88.8%（95% CI：0.619，0.903）；IL-6截断值为169.743 pg/mL，AUC为0.811（95% CI：0.743，0.879），特异性为97.5%（95% CI：0.814，0.991），敏感性为80.9%（95% CI：0.701，0.882）；TNF-α截断值为241.501 pg/mL，AUC为0.810（95% CI：0.738，0.883），特异性为93.8%（95% CI：0.798，0.976），敏感性为80.3%（95% CI：0.765，0.895）。血清IL-1β、IL-6及TNF-α水平预测腹腔镜胆囊切除术患者发生瑞芬太尼所致痛觉过敏风险的AUC均> 0.8，有一定预测价值。结论 腹腔镜胆囊切除术前血清IL-1β、IL-6、TNF-α可能是患者术后瑞芬太尼所致痛觉过敏发生的影响因素，临床可考虑通过术前检测各血清指标水平预测其术后发生瑞芬太尼所致痛觉过敏风险，对指导制订合理治疗方案有一定积极意义。

Abstract:

Objective To observe the expression of serum interleukin (IL) -1β, IL-6, and tumor necrosis factor-α (TNF-α) in patients with hyperalgesia caused by refractiofin after laparoscopic cholecystectomy, to analyze the relationship between the serum indexes and hyperalgesia, and to guide early prediction and intervention.Methods A total of 230 patients who underwent laparoscopic cholecystectomy in our hospital from April 2017 to November 2019 were selected. The patients were divided into the occurrence group and the non-occurrence group according to whether postoperative hyperalgesia due to remifentanil occurred. The preoperative serum IL-1β, IL-6, and TNF-α levels of the two groups were detected and compared; the correlation between serum indexes and the relationship with the hyperalgesia caused by remifentanil with those serum indexes were analyzed.Results Among the 230 patients who underwent laparoscopic cholecystectomy, 81 patients developed hyperalgesia due to remifentanil, the incidence rate was 35.22%; the levels of serum IL-1β, IL-6, and TNF-α in the occurrence group were higher than those in the non-occurrence group (P <0.05); the results of the two-variable Pearson linear correlation test showed that there were positive correlations of serum IL-1β with IL-6 and TNF-α, and of IL-6 with TNF-α in patients with laparoscopic cholecystectomy (r = 0.521, 0.567, and 0.474, all P< 0.05); Logistic regression analysis showed that the overexpression of serum IL-1β [O^R = 1.345 (95% CI: 1.012, 1.943) ], IL-6 [O^R = 1.782 (95% CI: 1.369, 1.991) ], and TNF-α [O^R = 1.593 (95% CI: 1.325, 1.992) ] were the influencing factors on patients had hyperalgesia caused by remifentanil during laparoscopic cholecystectomy (P< 0.05); ROC curve showed that the cut-off value of serum IL-1β was 23.156 pg/mL, AUC was 0.835 (95% CI: 0.773, 0.897), specificity was 96.3% (95% CI: 0.841, 0.987), and sensitivity was 88.8% (95% CI: 0.619, 0.903); the cut-off value of IL-6 was 169.743 pg/mL, AUC was 0.811 (95% CI: 0.743, 0.879), specificity was 97.5% (95% CI: 0.814, 0.991), and sensitivity was 80.9% (95% CI: 0.701, 0.882); cut-off value of TNF-α was 241.501 pg/mL, AUC was 0.810(95% CI: 0.738, 0.883), specificity was 93.8% (95% CI: 0.798, 0.976), and sensitivity was 80.3% (95% CI: 0.765, 0.895). The AUC of serum IL-1β, IL-6, and TNF-α for predicting the risk of remifentanil induced hyperalgesia in patients undergoing laparoscopic cholecystectomy were more than 0.8, which had a certain predictive value.Conclusion The overexpression of serum IL-1β, IL-6, and TNF-α before laparoscopic cholecystectomy may be an influencing factor for the occurrence of hyperalgesia caused by remifentanil in patients after surgery. Clinically, it can be considered to predict the risk of hyperalgesia caused by remifentanil with detecting various serum index levels before surgery, which has certain positive significance for guiding the formulation of reasonable treatment plans.