The Changes Of Opioids In The Peripheral Leukocytes And Plasma Of Diabetic Patients During Perioperative Period

Objective:To investigate the changes of plasma and leukocyte derived Leucine enkephalin(LEK),Dynorphin-A(Dyn-A),Endorphin(β-EP)during the perioperative period in diabetic patients.Methods:A total of 49 non-diabetic patients(NDM group)and 23 diabetic patients(DM group)undergoing lumbar fusion under elective general anesthesia were collected.The total counts of peripheral leukocytes(WBC),lymphocyte(L),monocyte(M),granulocyte(G)and calculation of granulocyte to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR)were recorded before and after operation.Before induction of anesthesia(T1),after the operation(T2),24 hours after operation(T3),blood samples from non-infusion elbow vein were collected.The plasma levels of leucine enkephalin(LEK),dynorphin-A(Dyn-A),β-endorphin(β-EP)were measured by enzyme-linked immunosorbent assay(ELISA).Flow cytometry(FCM)was used to measure the percentage and mean fluorescence intensity(MFI)of T1 and T2 leukocytes with fluorescent positive leucine endorphin(LEK),dynorphin-A(Dyn-A).Results:Compared with preoperative(Tl),The WBC,M,G counts and NLR ratios were increased and the L counts were decreased at T2 in the two groups(P<0.01).The plasma enkephalin(LEK),dynorphin-A(Dyn-A)and β-endorphin(β-EP)levels were significantlydecreased in DM group and NDM group during the perioperative period(P <0.01).Compared with the NDM group,the percentage of each type leukocytes with fluorescent positive Dyn-A was significantly increased at Tl in the DM group(P<0.05).Compared with T1,the percentage of each type leukocytes with fluorescent positive Dyn-A was reduced(P<0.05)at T2 in the DM group,but there was no significant change in the NDM group.The MFI of Dyn-A in granulocyte(G)was reduced in the NDM and DM group(P<0.05).Compared with preoperative,the percentage of LEK-positive cells in the NDM group showed a decreasing trend.Conclusion:The plasma levels of leucine enkephalin(LEK),dynorphin-A(Dyn-A),andβ-endorphin(β-EP)decreased during perioperative period in diabetic patients,and the content of Dyn-A in peripheral blood granulocyte(G)reduced after operation in the NDM and DM group.