Effect of combined propofol-sevoflurane anesthesia on immune function in pediatric patients with acute lymphoblastic leukemia.

Abstract

Effect of combined propofol-sevoflurane anesthesia on immune function in pediatric patients with acute lymphoblastic leukemia (ALL) was investigated. A retrospective analysis was performed on 150 pediatric patients with ALL who were admitted to Xiangyang No. 1 People's Hospital Affiliated to Hubei University of Medicine from May 2014 to October 2017. All eligible patients were treated with intrathecal chemotherapy and were randomized into three groups according to the type of anesthesia used: group A, propofol used only; group B, sevoflurane used only; and group C, combined propofol and sevoflurane used. Venous blood samples were drawn, respectively, at 30 min before anesthesia (T1) and 24 h after anesthesia (T2). Flow cytometry was used to detect the percentages of T- and B-cell subsets, as well as the ratio of Th1/Th2 in T helper cells (Th cells). Serum levels of IFNγ, IL-4 and TGF-β were measured using enzyme-linked immunosorbent assay. At T2, the percentages of CD3+, CD4+ and CD19+ cells in group C were significantly higher than those in groups A and B (P<0.05). The percentage of CD8+ cells in group C was significantly higher than that in group A (P<0.05). At T2, the percentages of Th1 and Th2 cells and the Th1/Th2 ratio in group C were higher than those in groups A and B (P<0.05). At T2, IL-4 level in group C was significantly higher than that in group A (P<0.05), while TGF-β level was significantly lower (P<0.05). The IFNγ level in group C was higher than those in groups A and B (P<0.05). The IFNγ/IL-4 ratio in group C was higher than that in group A (P<0.05). Combined propofol-sevoflurane anesthesia was more beneficial to the recovery of T/B cell subset activity, to the alleviation of immunosuppression, and the suppression of ALL progression, compared to the sole use of propofol or sevoflurane.