| Research background and Objective Anesthesia-related factors such as the method of anesthesia,anesthetic drugs and adjuvant medications have been shown to have a direct or indirect effect on the immune function of the body.The intravenous anesthetic drugs midazolam,propofol,and opioids can reduce the phagocytosis and chemotaxis of lymphocytes and macrophages by decreasing the cellular mitochondrial membrane potential and therefore inhibit the immune response.Alpha2-adrenoceptor agonists also directly stimulate the sympathetic nervous system and promote apoptosis of lymphocytes.Meanwhile,inhaled anesthetics inhibit the production of reactive oxygen clusters and impede neutrophil adhesion to endothelial cells in the presence of chemokines,thereby exerting a suppressive effect on immune function.Furthermore,different anesthetic modalities have different effects on immune function.Regional blocks were found to reduce vegetative nerve pressure and the effects of surgery and anesthesia on patients,with no significant effect on lymphocyte subsets.Whereas,general anesthesia significantly suppressed natural killer cell activity.Recent studies have reported a higher incidence of wound infection as well as herpes zoster after cesarean section with general anesthesia compared to regional anesthesia.This suggests that general anesthesia has a stronger effect on immunosuppression compared to regional anesthesia.In China,over 120 million people are infected with the hepatitis B virus,and around 30 million suffer from chronic hepatitis B.The risk of primary hepatocellular carcinoma in this population is at least 300 times higher than that in the general population,so the prevention and treatment of HBV has become a primary issue in the control of health and infectious diseases in China.Hepatitis B virus is a hepatophilic DNA virus that will rapidly reach liver tissue after entering the bloodstream and will be cleared by reticuloendothelial cells under normal circumstances.However,if the amount of virus exceeds the body’s clearance capacity,or if the body is in an immunosuppressed state,the hepatitis B virus may settle and replicate in liver tissue and other extrahepatic tissues.The replication and clearance of the hepatitis B virus in the body are closely related to the immune function of the body.Important roles are played by natural killer cells,monocytes,macrophages,and CD8+ T cells in hepatitis B virus infection.In summary,anesthesia affects immunity,and immunity affects the replication and clearance of the virus.Accordingly,we hypothesize that altered immune function after general anesthesia may affect perioperative hepatitis B virus replication,which can cause an increase in the level of virus in the body of patients with hepatitis B.However,in clinical practice,changes of hepatitis B virus in its carriers after non-hepatobiliary surgery have not been taken seriously,and the need for postoperative monitoring of viral levels and antiviral therapy has not been established.Therefore,this study investigated the effect of general anesthesia on the changes of serum hepatitis B virus levels in its carriers after the non-hepatobiliary minimally invasive surgery,to provide a reference for their postoperative antiviral treatment.We also conducted a retrospective study to analyze changes in several immune function related cells through the perioperative results from complete blood count(CBC),to assess the effects of several different narcotics on the immune function in patients with hepatitis B.1.Effects of General Anesthesia on Changes of Serum Hepatitis B Virus-DNA Levels in Infected Patients Underwent Non-Hepatobiliary Minimally Invasive Surgery Methods This study was a prospective observational study.Patients with chronic hepatitis B virus carriage who underwent non-hepatobiliary minimally invasive surgery under general anesthesia at the First Affiliated Hospital of the Army Military Medical University from March 2021 to January 2022 were selected for the study.According to the inclusion and exclusion criteria,patients were divided into intravenous general anesthesia group(Group P)and inhalation general anesthesia group(Group S)according to the randomized envelope method in a 1:1 ratio,and a total of 38 patients were included.According to the study protocol,preoperative assessments were conducted and basic patient information was collected.The induction of anesthesia was the same in both groups;for maintenance of anesthesia,propofol 2-3ug/ml TCI pump was the mainstay in group P,and sevoflurane 1.0-1.7 MAC inhalation was the mainstay in group B.The BIS values were maintained between 40 and 60.Assure that intraoperative blood pressure fluctuates at approximately 10% of the basal value.Patient’s blood was drawn before operation(Tbaseline),at 24 hours(Tpost 24hrs)and 48 hours(Tpost 48hrs)after operation to detect the serum HBV-DNA levels and analyze the subset levels of T,B lymphocytes and NK cells(TBNK)in two groups.The serum HBV-DNA level was used as the major outcome,and it was analyzed by repeated-measures analysis of variance after natural logarithm transformation.Results1)There was no significant difference in the demography information between the two groups.2)In Group P and Group S,compared with the baseline,the serum HBV-DNA levels decreased significantly at Tpost 24 hrs and Tpost 48 hrs(P<0.05).3)Compared with the baseline,CD4+T cells and ratio of CD4+T to CD8+T cells(CD4+/CD8+)were significantly lower at Tpost 24hrs(P<0.05),whereas they were higher at Tpost 48 hrs compared to Tpost 24hrs(P<0.05).4)B-cell levels were significantly higher at Tpost 24 hrs compared to Tbaseline(P<0.05)and Tpost 48 hrs compared to Tpost 24hrs(P<0.05).5)There was no significant difference between the two groups for each test index.2.Retrospective analysis of postoperative partial immune cell count changes in relation to anesthesia modality in HBV carriers Methods This study reviewed all patients with hepatitis B(hepatitis B surface antigen positive)undergoing surgical anesthesia from January 1,2018,to December 31,2020,at the First Affiliated Hospital of Army Military Medical University.A total of 1784 patients were collected according to the criteria.Eligible cases were divided into an intravenous general anesthesia group(Group P),an inhalation general anesthesia group(Group S),and a regional block group(Group R)according to the anesthesia method.Blood test time points were set at preoperative(T0),24 h postoperative(T1),48 h postoperative(T2),and one week postoperative(T3).Statistical analysis of lymphocyte,leukocyte,and monocyte counts in routine perioperative CBC was performed for each group of patients using repeated-measures analysis of variance.Results1)There was no significant difference in the demography information between the three groups of patients.2)Compared to T0,lymphocytes in the three groups showed a significant decrease at T1(P<0.05),with Group P and S showing a greater decrease than Group R;while at T2 and T3,lymphocytes were significantly elevated compared to T1(P<0.05).3)Compared to T0,leukocytes significantly increased in T1 in all three groups(P<0.05),while in T2 and T3,leukocytes decreased compared to T1(P<0.05).4)Monocytes were markedly higher in all groups at all 3 postoperative assays compared to T0,while there were no significant differences at any postoperative time points between groups.5)There was no significant difference in every test index between Groups P and Groups S.Conclusions1)Serum HBV-DNA levels decreased within 48 hours after general anesthesia in patients with hepatitis B undergoing non-hepatobiliary minimally invasive surgery,and there was no significant difference between the effects of intravenous general anesthesia and inhalation general anesthesia on serum HBV-DNA levels.2)After general anesthesia and regional block anesthesia,lymphocytes in patients with hepatitis B virus carriage showed a significant decrease and did not return to preoperative levels until 1 week after surgery.In general anesthesia patients,lymphocytes decreased more significantly and recovered more slowly than in regional block patients.In addition,there was no significant difference between intravenous anesthesia and inhalation anesthesia. |
