树突状细胞疫苗联合细胞因子诱导的杀伤细胞腹腔灌注治疗恶性腹腔积液临床效果观察

目的 观察树突状细胞（DC）疫苗联合细胞因子诱导的杀伤细胞（CIK细胞）腹腔灌注治疗恶性腹腔积液的安全性和有效性.方法 回顾性分析51例传统治疗失败的恶性腹腔积液患者的治疗情况.治疗组（22例）采用血细胞分离机采集外周血单个核细胞（PBMC）,经体外诱导培养成DC和CIK细胞.将DC和CIK细胞混匀后进行腹腔灌注,隔日1次,共3次;对照组（29例）仅进行姑息性穿刺排出腹腔积液及利尿处理.观察所有患者治疗前后外周血淋巴细胞亚群变化;参照WHO癌性积液疗效评价标准和常见不良反应评价标准（NCI-CTCAE v4.0）评价近期临床疗效和安全性;根据Karnofsky功能状态评分评估患者生活质量（QOL）改变.结果 治疗组外周血中CD4＋ CD25＋调节性T细胞（Treg细胞）比例升高较对照组缓慢,差异有统计学意义（P＜0.05）.治疗组有效率（RR） 40.9％（9/22）,疾病控制率（DCR） 77.3％（17/22）,对照组RR为10.3％（3/29）,DCR为27.6％（8/29）,两组差异均有统计学意义（均P＜ 0.05）.治疗组QOL改善13例（59.1％）,稳定5例（22.7％）,降低4例（18.2％）;对照组QOL改善3例（10.3％）,稳定5例（17.2％）,降低21例（72.4％）,两组差异有统计学意义（P＜0.05）.治疗组所有患者均未出现3～4级不良反应.结论 DC疫苗联合CIK细胞腹腔灌注治疗恶性腹腔积液是安全的,即使在传统治疗效果不佳或失败时也可以取得一定临床获益.

Observation on clinical effects of dendritic cell vaccines combined with cytokine-induced killer cells intraperitoneal injection on patients with malignant peritoneal effusion

Objective To evaluate the safety and efficacy of dendritic cell （DC） vaccines combined with cytokine-induced killer （CIK） cells intraperitoneal injection on patients with malignant peritoneal effusion.Methods Clinical data of 51 patients with malignant peritoneal effusion after the failure of conventional treatment methods were analyzed retrospectively.Peripheral blood mononuclear cells （PBMC） were collected by blood cell separator from 22 patients of treatment group.PBMC were cultured in vitro to produce DC vaccines and CIK cells.DC and CIK cells were injected peritoneally with the cell mixture,q.o.d,3 times.The patients of control group were dealt with peritoneal puncture and diuretic therapy.The changes of peripheral blood lymphocyte subsets between pre-and post-treatment were evaluated.Short-term clinical efficacy was evaluated according to WHO cancerous effusion criteria and safety according to NCI-CTCAE v4.0 version criteria respectively.The changes of patients＇ quality of life （QOL） were evaluated according to Karnofsky score.Results The percentage CD4＋ CD25＋ Treg cells in treatment group slowly declined after treatment compared with control group （P ＜ 0.05）.The clinical response rate （RR） was 40.9 ％ （9/22） and disease control rate （DCR） was 77.3 ％ （17/22） in treatment group.The RR was 10.3 ％ （3/29） and DCR was 27.6 ％ （8/29） in control group.There was significant differences in RR and DCR between treatment group and control group （P ＜ 0.05）.There were thirteen cases with QOL improvement,five cases with QOL stability,four cases with QOL decrease after treatment in treatment group.There were three cases with QOL improvement,five cases with QOL stability,twenty-one cases with QOL decrease after treatment in control group.There was significant difference in QOL between treatment group and control group （P ＜ 0.05）.No grade 3-4 adverse event happened in all cases.Conclusions DC vaccines combined with CIK cells intraperitoneal injection on pa