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Effects of propofol and sevoflurane on T-cell immune function and Th cell differentiation in children with SMPP
Hui Yu1, Lin Chen1, Cheng-Jin Yue1
1Department of Anesthesiology, Hubei Women and Children's Hospital, Tongji Medical College, Huazhong University Science & Technology, Wuhan, Hubei, China.
Insights
Propofol demonstrated a less inhibitory effect on T lymphocytes and better preserved the Th1/Th2 ratio in children with severe mycoplasmal pneumonia compared to sevoflurane. This suggests propofol may support immune function during anesthesia for this condition.
Area of Science:
- Immunology
- Anesthesiology
- Pediatrics
Background:
- Severe mycoplasmal pneumonia (SMPP) in children is associated with immune dysfunction.
- Common anesthetic agents like propofol and sevoflurane may impact T-cell immune function.
- Understanding these effects is crucial for optimizing patient care during procedures like bronchoscopy.
Purpose of the Study:
- To investigate the differential effects of propofol and sevoflurane on T-cell immunity and Th cell differentiation in children with SMPP.
- To compare clinical outcomes and immune parameters between anesthetic groups.
Main Methods:
- A randomized study of 60 children (2-12 years) with SMPP undergoing fiberoptic bronchoscopy.
- Patients were randomized to receive either inhalational sevoflurane or intravenous propofol, both with remifentanil.
- Immune function, including T-cell counts and Th1/Th2 differentiation, was assessed post-procedure.
Main Results:
- No significant differences in clinical outcomes or hospital stay were observed between the propofol and sevoflurane groups.
- The propofol group showed significantly higher CD3+, CD4+ T cells, and CD4+/CD8+ ratios compared to the sevoflurane group.
- The Th1/Th2 ratio increased postoperatively in both groups, with a significantly greater increase in the propofol group.
Conclusions:
- Propofol appears to have a less inhibitory effect on T lymphocytes in children with SMPP than sevoflurane.
- Propofol may better preserve Th1/Th2 cell differentiation and maintain balanced immune function compared to sevoflurane in this pediatric population.
- Further research is warranted to elucidate the immunomodulatory effects of anesthetic agents in SMPP.
Objectives:
The potentially different effects of commonly used anaesthetic agents propofol and sevoflurane on T-cell immune function and Th cell differentiation were investigated in patients with severe mycoplasmal pneumonia (SMPP) undergoing fibreoptic bronchoscopy.
Methods:
Sixty children (2-12 years of age) with SMPP were randomized into the sevoflurane group and the propofol group. Patients in the sevoflurane group were anaesthetised with inhalational sevoflurane and intravenous remifentanil. Patients in the propofol group were anaesthetised with intravenous propofol and remifentanil. Patients in both groups underwent fibreoptic bronchoscopy and lavage therapy. We compared the clinical outcomes, cellular immunity function, and Th cell differentiation into Th1 and Th2 levels in both groups.
Results:
There was no significant difference in clinical outcomes and hospital stay between the two groups (7.94 vs 7.36, p > .05). However, the CD3+ T cells, CD4+ T cells, and CD4+/CD8+ in the propofol group were significantly higher than those in the sevoflurane group (T1 51.96 vs 48.33, T2 58.08 vs 55.31, p < .05). The ratio of Th1/Th2 in the two groups was significantly increased postoperatively in both groups (Sevoflurane 8.53 vs 7.23, Propofol 9.35 vs 7.18), and the propofol group was significantly higher than the sevoflurane group (9.35 vs 8.53, p < .05).
Conclusions:
Propofol might have a less inhibitory effect on T lymphocytes in children with SMPP than sevoflurane. And propofol may have less impact on the differentiation of Th cells into Th1 cells and better preserving the Th1/Th2 ratio than sevoflurane. KEY MESSAGESThe pathogenesis of SMPP is still unclear, likely through alveolar infiltration with neutrophils and lymphocytes, lymphocyte/plasma cell infiltrates in the peri-bronchovascular area, and immune dysfunction.Recent experimental and clinical studies showed that sevoflurane might have immunosuppressive effects, and multiple studies confirmed that the immune function of children with SMPP had been reduced.This study found that propofol administered in children with SMPP had a less inhibitory effect on T lymphocytes than inhalational sevoflurane, had little inhibitory effect on the differentiation of Th cells into Th1 cells, and better preserve Th1/Th2 ratio and maintain the balanced immune function.
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