分化型甲状腺癌细胞免疫与侵袭性的相关性

目的 探讨分化型甲状腺癌(DTC)免疫状态与侵袭性的关系。方法 以2012年9月至12月在北京协和医院核医学科就诊的74例DTC患者为研究对象,根据有无包膜侵犯分为侵犯组(n=36)和未侵犯组(n=38),有无远处转移分为转移组(n=18例)和未转移组(n=56),选择NK细胞和T细胞亚群作为细胞免疫指标,探讨细胞免疫与甲状腺癌侵袭性的相关性。结果 单因素分析结果显示,包膜侵犯(χ²=12.175,P=0.000)和远处转移(χ²=8.139,P=0.006)与细胞免疫指标异常相关,远处转移与是否合并桥本氏病相关(χ²=7.094,P=0.008);进一步分析结果显示,远处转移与CD8+T细胞异常(χ²=5.429,P=0.020)相关,包膜侵犯与NK细胞异常(χ²=2.445,P=0.018)和CD4/CD8异常(χ²=8.079,P=0.002)相关。多因素分析结果显示,细胞免疫异常是包膜侵犯OR=5.701,95%CI(2.075～15.666),P=0.001]和远处转移OR=5.063,95%CI(1.571～16.320),P=0.008]的危险因素;进一步分析结果显示,CD8+异常是远处转移的危险因素OR=2.236,95%CI(1.084～4.613),P=0.029],CD4/CD8异常是包膜侵犯的危险因素OR=2.802,95%CI(1.257～6.244),P=0.012]。结论 DTC患者免疫状态与肿瘤的局部侵袭和远处转移密切相关,当CD8+T细胞百分比降低和NK细胞、CD4/CD8异常时,易出现局部侵袭和远处转移。

Correlations between Cellular Immunity and Invasiveness in Differentiated Thyroid Cancer

Objective To investigate the relationship between the immunity and invasiveness in differentiated thyroid cancer(DTC).Methods Totally 74 DTC who were treated in Peking Union Medical College Hospital from September 2012 to December 2012 were enrolled in this study.These 74 patients were divided into membrane invasion group(n=36)and without membrane invasion group(n=38);also,they were divided into distant metastasis group(n=18)and without distant metastasis group(n=56).Natural killer(NK)cells and T-cell subsets were chosen as indicators for cellular immunity to investigate the correlation between cellular immunity and invasiveness in DTC.Results Univariate analysis showed that the membrane invasion(χ²=12.175,P=0.000)and distant metastasis(χ²=8.139,P=0.006)correlated with cell immunity,whereas distant metastasis correlated with lymphocytic thyroiditis(χ²=7.094,P=0.008).Further investigation shows that distant metastasis was associated with the percentage of CD8+T cell subgroup(χ²=5.429,P=0.020),and membrane invasion was significantly associated with NK cells(χ²=2.445,P=0.018)and CD4/CD8 disorder subgroup(χ²=8.079,P=0.002).Multivariate analysis showed that cell immunity disorder was a risk factor for membrane invasionOR=5.701,95%CI(2.075~15.666),P=0.001]and distant metastasisOR=5.063,95%CI (1.571~16.320),P=0.008].Further analysis showed that CD8+T cell was a risk factor for metastasisOR=2.236,95%CI( 1.084~4.613),P=0.029],and CD4/CD8 disorders were the risk factors for membrane invasionOR=2.802,95%CI(1.257~6.244),P=0.012].Conclusion Cell immunity in thyroid cancer has close relationship with membrane invasion and distant metastasis,especially when the percentage of CD8+T cells decreases and when the NK cells and CD4/CD8 are abnormal,which may lead to membrane invasion and distant metastasis.