乳腺癌患者细胞免疫水平与预后危险因素的关系及临床意义

目的：探讨乳腺癌患者细胞免疫状态与预后危险因素之间的关系。方法：回顾性分析1997年至2002年收治的110例女性乳腺癌患者的临床资料，分析其一般情况及CD⁺₃T、CD⁺₄T、CD⁺₈T、CD⁺₄/CD⁺₈、淋巴细胞转化率（LTR）的变化及其与乳腺癌肿块大小、淋巴结转移情况及癌胚抗原（CEA）的关系。结果：①乳腺癌不同肿块大小患者中CD⁺₄T、CD⁺₈T、CD⁺₄/CD⁺₈水平差异有统计学意义（P＜0.01或P＜0.05），在肿块较小时即有CD4+T水平的降低和CD⁺₈T水平的升高，而CD⁺₄/CD⁺₈水平随着肿瘤负荷的增大而降低；②淋巴结转移组［LN(+)］与未转移组［LN(-)］比较，CD⁺₄/CD⁺₈在LN(+)组中显著降低(P＜0.05)；CD⁺₃T、CD⁺₄T、CD⁺₈T在LN(+)组中表达增高，CD⁺₃T、CD⁺₈T的升高有统计学意义(P＜0.05或P＜0.01)。 ③CEA在LN(+)组中明显升高(P＜0.05), 在不同肿瘤负荷组间比较差异无统计学意义（P＞0.05）。CEA（+）组和CEA（-）组之间比较，CD⁺₄T升高及CD⁺₄/CD⁺₈水平降低差异均有统计学意义（P＜0.01）, 且CEA与CD⁺₄T及CD⁺₄/CD⁺₈水平密切相关（P＜0.01）。结论：乳腺癌患者存在不同程度的细胞免疫状态紊乱，且与乳腺癌CEA水平及肿块大小、淋巴结转移情况密切相关。

Relationship between cytoimmunologic status and prognosis of patients with breast cancer

To investigate the cytoimmunologic status of patients with breast cancer and its relationship with prognostic risk factors. Methods： One hundred and ten patients with breast cancer in Shandong Provincial Hospital between 1997 and 2002 were retrospectively analyzed. Clinical features, as well as the alternation of CD⁺₃T, CD⁺₄T, CD⁺₈T, CD⁺₄/CD⁺₈ and LTR and their relationship with mass size, metastasis of lymph nodes and CEA were also analyzed. Results： ①There were statistical differences in the percentage of CD⁺₄T and CD⁺₈T and the ratio of CD⁺₄/CD⁺₈ between groups of different mass sizes (P＜0.05 or P＜0.01). The percentage of CD⁺₄T was decreased and of CD+8T was increased when mass size was small. The ratio of CD⁺₄/CD⁺₈ went down with an increase of mass size. ②Percentages of CD⁺₃T and CD⁺₈T in patients with metastasis of axillary lymph nodes［LN(+)］ were significant higher than those without metastasis of axillary lymph nodes ［LN(-)］ (P＜0.05 or P＜0.01). ratioin patients with metastasis of LN(+) than those without metastasis of LN(-) (P＜0.05 or P＜0.01). The percentage of CD⁺₄T was higher in patients with metastasis of LN(+)than in patients without metastasis of LN(-), but no significant difference was found(P＞0.05). ③The CEA level was significant higher in patients with metastasis of LN(+) than in patients without metastasis of LN(-) (P＜0.05), and no such difference was shown between different mass-size groups(P＞0.05). The increase of CD⁺₄T percentage and the decrease of CD⁺₄/CD⁺₈ ratio were obvious in the CEA(+) group compared with the CEA(-) group(P＜0.01), and CEA was significantly correlated with the CD⁺₄T percentage and the CD⁺₄/CD⁺₈ ratio (P＜0.01). Conclusion： Disorder of the cytoimmunologic situation exists in patients with breast cancer, and it is closely correlated with the highly prognostic factors of mass size and the metastasis situation of axillary lymph nodes.