术前栓塞化疗对肝癌术后免疫功能的影响

背景与目的:经肝动脉栓塞化疗(transcatheterarterialchemoembolism,TACE)是治疗肝癌的重要手段之一,术后TACE能明确降低复发率,但术前TACE的作用和地位尚有争议。本研究探讨术前TACE对肝癌术后复发患者综合治疗时免疫功能的影响。方法:收集术前TACE原发性肝癌患者,用流式细胞仪和ELISA法分别检测介入前、手术前、复发综合治疗时细胞免疫和体液免疫的动态变化,并与同期直接手术术后复发的综合治疗患者比较。结果:术前TACE组CD3+、CD4+、CD56+轻度降低,血清IgM水平轻度上升,与介入前无显著性差别(P>0.05),复发综合治疗时主要表现为CD8+上升和CD4+/CD8+比例下降(0.8±0.3)%,免疫抑制程度较轻。直接手术组CD3+、CD4+、CD56+分别为(49.0±9.1)%、(19.0±4.8)%、(18.6±9.9)%,免疫抑制程度较重,手术明显降低患者CD3+、CD4+、CD19+水平。术后病理检查表明术前TACE组的肿瘤包膜变完整、子灶、癌栓减少,根治切除率高于直接手术组。结论:术前栓塞化疗对原发性肝癌手术患者免疫功能影响不大,可弥补手术不足,明显减轻肝癌切除术后患者细胞免疫和体液免疫抑制,但应掌握适应证。

Influence of preoperative transcatheter arterial chemoembolism on immunity after hepatectomy in patients with liver cancer

BACKGROUND & OBJECTIVE: Transcatheter arterial chemoembolism (TACE) is one of important therapeutic method for hapatocarcinoma. Post-operative TACE could reduce recurrent rate definitely. However, there were much debate about the function and effect of preoperative TACE. This study was conducted to evaluate the effect of preoperative TACE on immunity of the patients with recurrent hepatocarcinoma who performed combined treatment. METHODS: The patients with primary hepatocarcinoma who performed operative TACE were collected. The dynamic changes of cellular immunity and humoral immunity in pre-intervention, pre-operation, combined treatment after recurrence periods were determined by flow cytometry and ELISA, and were compared with the data of the recurrent patients after simple operation. RESULTS: In TACE group: CD3, CD4, CD56 decreased slightly; serum IgM increased slightly, with no significant difference compared to pre-intervention (P < 0.05); At the time of combined treatment after recurrence, CD8 increased and CD4/CD8 decreased (0.8 +/- 0.3%), the immune suppression was slight. In sample operation group, CD3, CD4, CD56 were 49.0 +/- 9.1%, 19.0 +/- 4.8%, 18.6 +/- 9.9%; the immune suppression was severe. The operation significantly decreased the patients' CD3, CD4, and CD19. The pathologic results showed that the tumor capsule, intrahepatic daughter foci, tumor thrombus, and the radical degree in preoperative group were much better than those in simple operation group. CONCLUSION: The preoperative TACE do not obviously influence the immunity; furthermore, it can relieve the immune depression after operation and is a remedy of the surgical treatment. It is important to grasp the indication of preoperative TACE.