结直肠癌患者CD4+、CD8+T淋巴细胞介导免疫功能的影响因素

目的:探讨结直肠癌患者(colorectal cancer,CRC)CD4+、CD8+T淋巴细胞介导的细胞免疫功能与术前检查肿瘤标记物，患者术前基础疾病和一般情况之间的关系,研究发现影响CRC细胞免疫功能的高危因素。方法:收集2010年02月至2020年06月广西科技大学第二附属医院普通外科218例CRC患者完整的细胞免疫，肿瘤标志物，患者术前基础疾病和一般情况等资料，对数据进行统计描述，临床上界定各检验指标的正常值范围:细胞免疫CD4+和CD4+/CD8+的正常值分别为320~1 250个/μL和0.9~2.0；肿瘤标记物CEA,CA199,CA125,CA153,CA242,CA724的正常值范围分别为0~5 μg/L，0~37 μg/L，0~35 μg/L，0~31.3 μg/L，0~20 μg/L，0~5.7 μg/L。临床上常以患者外周血液检测中的CD4+T淋巴细胞计数或CD4+/CD8+比值低于正常值范围定义为患者的细胞免疫功能低下。对其进行回顾性研究分析,采用统计学SPSS 24.0统计软件,对计量资料用P-P图做正态性检验，对数据先进行单因素分析,有统计学意义的因素进入多因素二元Logistic回归分析的方法,研究发现结直肠癌患者CD4+、CD8+T淋巴细胞介导的细胞免疫功能与各临床参数之间的关系。结果:男性的CD4+水平低于女性,差异有统计学意义（P＜0.05）。血型对细胞免疫功能影响无统计学差异（P＞0.05）。CEA和CA199升高组CD4+水平均低于正常组，差异有统计学意义（P＜0.05）。年龄、T分期、术前心血管病分组、呼吸系统疾病分组的患者细胞免疫功能低下率差异无统计学意义（P＞0.05）。术前患有糖尿病患者细胞免疫功能低下率高于术前未患糖尿病患者，差异有统计学意义（P＜0.01）,术前有吸烟史患者细胞免疫功能低下率高于术前无吸烟史患者，差异有统计学意义（P＜0.01）。CRC细胞免疫功能影响因素的二元Logistic多因素回归分析:术前糖尿病史和术前有吸烟史是导致细胞免疫功能低下的危险因素(OR=5.372,95%CI:2.656~10.865,P＜0.001;OR=4.467,95%CI:2.105~9.476,P＜0.001）。结论:术前有糖尿病史和术前有吸烟史是影响CRC的CD4+、CD8+T淋巴细胞介导的细胞免疫功能低下的独立危险因素,其中术前有吸烟史最显著。患者的性别，术前检查肿瘤标记物CEA和CA199水平对判断CRC细胞免疫功能有一定的参考价值。

Influencing factors of CD4+,CD8+T lymphocyte mediated immune function with colorectal cancer

Objective:To investigate the relationship among CD4+,CD8+T lymphocyte mediated cellular immune function,preoperative tumor markers,preoperative basic diseases and general conditions with colorectal cancer (CRC),and to find out the high-risk factors affecting the CRC immune function.Methods:The complete data of cellular immunity,tumor markers,preoperative basic diseases and general conditions of 218 CRC patients in the general surgery department of the Second Affiliated Hospital of Guangxi University of Science and Technology were collected from February 2010 to June 2020.The data were statistically described and the normal value range of each test index was defined clinically:The normal values of CD4+ and CD4+/CD8+ are 320~1 250/μL and 0.9~2.0 respectively.The normal range of tumor markers CEA,CA199,CA125,CA153,CA242,CA724 are 0~5 μg/L，0~37 μg/L，0~35 μg/L，0~31.3 μg/L，0~20 μg/L，0~5.7 μg/L respectively.In clinical practice,the CD4+T lymphocyte count or the CD4+/CD8+ ratio in peripheral blood tests are often lower than the normal value range,which is defined as the cellular immunodeficiency of patients.The statistical software SPSS 24.0 was used to test the normality of the measurement data with P-P chart.Results:The level of CD4+ in male was lower than that in female,the difference was statistically significant（P＜0.05）.There was no significant difference in the effect of blood group on cellular immune function（P＞0.05）.The levels of CD4+ in CEA and CA199 increased group were lower than that of normal group,the difference was statistically significant（P＜0.05）.There was no significant difference in the rate of cellular immune dysfunction between the age,T stage,preoperative cardiovascular disease group and respiratory disease group（P＞0.05）.The rate of cellular immune dysfunction in patients with diabetes mellitus before operation was significantly higher than that in patients without,the difference was statistically significant（P＜0.01）.The rate of cellular immune dysfunction in patients with preoperative smoking history was significantly higher than that in patients without,the difference was statistically significant（P＜0.01）.Binary logistic regression analysis of influencing factors on CRC cellular immune function showed preoperative diabetes mellitus and preoperative smoking history were the risky factors for low cellular immune function (OR=5.372,95%CI:2.656~10.865,P＜0.001.OR=4.467,95%CI:2.105~9.476,P＜0.001).Conclusion:Preoperative diabetes and preoperative smoking history are the independent risky factors of CD4+,CD8+T lymphocyte mediated low cellular immune function with colorectal cancer,among which preoperative smoking history is the most significant.The gender of the patients,preoperative examination of tumor markers CEA and CA199 levels have certain reference value for judging the cellular immune function with colorectal cancer.