脑胶质瘤患者T淋巴细胞亚群检测的临床意义

目的 探讨T淋巴细胞亚群与胶质瘤恶性程度及其预后的关系,寻找术前评估胶质瘤恶性程度及其预后的临床免疫学指标. 方法 对中山大学肿瘤防治中心神经外科自2003年1月至2004年12月收治住院的117例脑肿瘤患者其中胶质瘤共85例,高级别组(WHO Ⅲ～Ⅳ级)45例,低级别组(WHO Ⅰ～Ⅱ级)40例;脑膜瘤32例]术前用流式细胞仪(FACS)测定T淋巴细胞的含量,统计分析不同级别胶质瘤、脑膜瘤之间免疫学指标的差异,并依据术前外周血T淋巴细胞亚群检测结果,把胶质瘤患者分为CIM+/CD8~+比值>1及CD4~+/CD8~+比值<1两组,随访3～5年,作生存分析,比较两组之间的差异. 结果 统计分析结果显示,高级别胶质瘤组较低级别胶质瘤组CD4~+/CD8~+比值下降、CD8~+升高,差异均有统计学意义(P<0.05),其余指标差异无统计学意义.高级别胶质瘤组较脑膜瘤组CD4~+/CD8~+比值下降、CD8~+升高,差异均有统计学意义(P<0.05),其余指标差异尤统计学意义.低级别胶质瘤组较脑膜瘤组CD4~+/CD8~+比值下降,差异有统计学意3L(P<0.05),其余指标差异无统计学意义.胶质瘤组与脑膜瘤组比较,CD4~+、CD4~+/CD8~+值下降、CD8~+升高,差异均有统计学意义(P<0.05),CD3~+差异无统计学意义.CD4~+/CD8~+比值>1组患者48例随访3～5年,死亡21例(43.8%),中位生存期31个月;CD4~+/CD8~+比值<1的患者37例,死亡23例(62.2%),中位生存期16个月.两者行生存分析Kaplan Meier法检验,差异有统计学意SL(P<0.05). 结论 术前外周血T淋巴细胞亚群与胶质瘤的恶性程度相关.CD4~+/CD8~+比值低的患者生存时间较短,预后差.术前外周血T淋巴细胞哑群检测可以作为临床评估胶质瘤恶性程度及预后的参考指标.

Detection of T lymphocyte subsets in patient with glioma

Objective To explore the relationship between T lymphocyte subsets and both glioma malignancy and its prognosis, and determine a clinical immunologic index for evaluating preoperative glioma malignancy and its prognosis. Methods The data of 117 inpatients with primary intracranial tumors, including glioma (n=85) and meningioma (n=32), were retrospectively analyzed. Fluorescence-activated cell sorting (FACS) analysis was performed to detect the preoperative contents of T lymphocyte subsets on 32 patients with meningioma and patients with glioma, including 45 high-grade glioma (WHO, grade Ⅲ-Ⅳ) and 40 low-grade glioma (WHO, grade Ⅰ -Ⅱ); and then the differences of their immunologic indexes were analyzed. Based on the detection result of T lymphocyte subsets, patients with glioma were divided into two groups: CD4~+CD8~+<1 and CD4~+CD8~+>1. Follow-up for 3-5 years was performed and the survival difference of these two groups was analyzed. Results Patients with high-grade glioma showed a decreased ratio of CD4~+CD8~+ and an increased value of CD8~+ with significant difference as compared with patients with low-grade glioma (P<0.05); patients with high-grade glioma showed a decreased ratio of CD4~+CD8~+, and an increased value of CD8~+ with statistical significance compared with patients with meningioma (P <0.05); patients with low-grade glioma showed a decreased ratio of CD4~+CD8~+ with statistical significance compared with the patients with meningioma (P<0.05). Patients with glioma showed a decreased ratio of CD4~+CD8~+ and CD4~+, and an increased CD8~+ with statistical significance compared with patients with meningioma (P<0.05). After follow-up for 3-5 years, 48 patients with glioma was found in the CD4~+CD8~+>1 group with 21 death (43.8%) and 31 months as a median survival time; 37 patients with glioma was found in the CD4~+CD8~+<1 group with 23 death (62.2%) and 16 months as a median survival time. The Kaplan-Meier survival curves were analyzed with statistical significance (P<0.05). Conclusion The prognosis is poor in patients with low ratio of CD4~+CD8~+. The preoperative level of T lymphocyte subsets in peripheral blood, correlated to the glioma malignancy, can be considered as an index to evaluate the glioma malignancy and the prognosis in patients with glioma.