阿片类药物和癌症生存率:我们是否在错误的地方寻找?
Despina Giakomidi1, Mark F Bird1, David G Lambert1
1Department of Cardiovascular Sciences (Anaesthesia, Critical Care and Pain Management), University of Leicester, Hodgkin Building, Leicester, UK.
BJA open
|August 17, 2023
概括
该研究质疑在麻醉中使用的阿片类药物是否会影响癌症存活率. 它提出,阿片类药物可能与托尔类受体4 (TLR4) 相互作用,而不仅仅是阿片类受体,可能会影响患者的结果.
科学领域:
- 麻醉学 麻醉学
- 免疫学 免疫学 免疫学
- 在瘤学瘤学.
背景情况:
- 一个有争议的叙述表明麻醉,包括阿片类药物,可能会损害瘤切除后的生存率.
- 假设阿片类药物对癌症的影响包括免疫抑制,血管生成促进和瘤生长支持.
- 该机制可能涉及阿片类药物与托尔类受体4 (TLR4) 的相互作用,而不是仅仅涉及阿片类受体.
研究的目的:
- 调查麻醉技术 (阿片类药物) 与癌症患者存活率之间的有争议的联系.
- 探索托尔类受体4 (TLR4) 在调解阿片类药物对癌症影响中的潜在作用.
- 确定将焦点从阿片类受体转移到TLR4是否可以为瘤学中的外科手术期间麻醉选择提供信息.
主要方法:
- 关于麻醉技术和癌症存活率的回顾性和正在进行的前性研究的审查.
- 检查有关阿片类药物与免疫细胞,血管生成和瘤生长相互作用的证据.
- 分析托尔类受体4 (TLR4) 的作用及其与阿片类药物的潜在相互作用.
主要成果:
- 对阿片类药物诱导的血管生成和瘤生长支持的证据尚不清楚.
- 阿片类受体不太可能存在于免疫细胞上,这表明了另一种机制.
- 越来越多的证据表明,阿片类药物可能与免疫细胞,内皮和瘤细胞上的Toll-like受体4 (TLR4) 相互作用.
- 已知TLR4激活促进免疫激活,血管生成和瘤存活.
结论:
- 癌症中对阿片类受体的关注可能是错误的;通类受体4 (TLR4) 相互作用是潜在的替代机制.
- 不同的阿片类药物可能具有不同的阿片类受体和TLR4激活的不同配置,可能会影响患者的治疗结果.
- 了解这些差异性相互作用可能会导致基于证据的指导方针,用于在癌症麻醉中进行外科手术期间的阿片类药物使用.
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