| Objective: To compare continuous intrathecal morphine analgesia with other methods of morphine analgesia on the effect of the T lymphocyte subsets and the T helper lymphocytes and on the analgesic efficacy of morphine on patients with severe cancer pain.Methods: Forty patients with severe cancer pain, aged 25 to 75 years old, NRS score> 6, expected survival > 1 month, conscious, no significant liver or kidney dysfunction, no significant respiratory depression, no history of opioid drug allergies and abuse, were enrolled. According to the wishes of the patient, subjects were randomly divided into two groups. Research group: to receive continuing intrathecal morphine analgesia; control group: to accept non-intrathecal morphine analgesia route. All underwent spinal X-ray or CT scan to confirm no spinal tumors or destruction in the vertebral body. Intrathecal catheter was placed the position of the pain. Through the subcutaneous cableway, the end of the catheter was connected with drug pump that was buried subcutaneously at the junction of hypochondrium axillary midline. Intrathecal analgesia was acted with the IDDS which has been injected with a dose of morphine. Other patterns of morphine analgesia were in the control group. The cell counts of T lymphocyte subsets CD3+、CD4+、CD8+、CD4+/CD8+ and NK cells were recorded in the two groups of patients before intrathecal injection(T0), 1 day after intrathecal injection(T1), 7 days after intrathecal injection(T2), 15 days after intrathecal injection(T3), and 30 days after intrathecal injection(T4). Mean whiles, the plasma cytokines IFN-γ、IL-2、IL-4、IL-10、IL-17 were measured by ELISA. Pain numeric rating method(NRS) score, the amount of morphine, the incidence of nauseaand vomiting, urinary retention, pruritus, and constipation and other complications of two groups of patients were recorded at the periods of T0、T1、T2、T3、T4 as well as the quality of life of these patients.Result:All patients with server cancer pain(NRS>6) are enrolled in this study. There are no significant different characters in all patients of two groups. Before the intrathecal injection(T0) and in postoperative 7 days(T2), the peripheral T lymphocyte subsets(CD3+、CD4+、CD8+、CD4+/CD8+) and NK cell counts showed no significant difference in two groups. But, in 1 day after surgery(T1), the cell percentages of T lymphocyte subsets CD3+、CD4+、CD8+、CD4+/CD8+ and NK cells of experimental group patients declined, and there was a significant difference compared with the controls(P < 0.05). At T3 and T4, the cell percentages of T lymphocyte subsets CD3+、CD4+、CD8+、CD4+/CD8+and NK cells of research group patients were significantly higher than the controls(P <0.05). At T4, the cell percentage of T lymphocyte subsets CD8+ in the control group was higher than that of the research group(P <0.05).The results of the comparison in the levels of cytokines with two groups of patients at T0、T1、T2、T3、T4 as follow: T0, the difference between the two groups was not statistically significant; at T1, were lower than the control group. The difference was statistically significant(P <0.05), but the levels of IL-4, IL-17 were significantly higher(P <0.05); At T3、 T4, the levels of IL-2, IFN-γin the research group were higher, and the IL-4、 IL-10、IL-17 levels were significantly lower than the control group(P <0.05). In two groups of patients at T0、 T1、 T2、T3、T4, digital grading pain scores were between 1.91 ± 0.78, no significant difference in comparison. And the results of quality of life showed that in T2、T3、 T4, the research group scored 52 ± 2、 53 ± 2、 54 ± 1(P < 0.05); the average daily dosage of morphine in the control group were 234.5mg、 268.3mg,、300.1mg、 325.2mg, while in the research group, the dosage was 1.3mg,、1.6mg、 4.3mg、6.5mg, there are significant differences between two groups(P <0.01). In the control group, the percentage of that have nausea and vomiting were much more than that of the research group( 2:1,50%Vs25%,P<0.05),the percentage of that have constipation were much more than that of the research group( 5:0,25%Vs0%,P<0.05),there are significant differences between the two groups(P <0.05). In addition, 2 cases occurred urinary retention, one case pruritus, one case somnolence occurs. But in the research group, case number of these side effects were 4 cases, 0 cases, one case, 0 cases, 0 cases 。Conclusion: continuous intrathecal injection of morphine analgesia method for severe cancer pain patients compared with other analgesic methods can significantly reduce the cancer pain and inhibit the levels of NK cells and T helper lymphocytes, T lymphocyte subsets by morphine. It also can reduce the dosage of morphine. |
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