围非小细胞肺癌手术期T细胞含量变化的研究

目的 通过分析非小细胞肺癌(non-small-cell carcinoma,NSCLC)患者外周血淋巴细胞Th1和Th2细胞水平,研究NSCLC患者术前术后T淋巴细胞亚群的变化,为临床上对NSCLC疾病的预防、诊断及治疗提供参考依据。方法 收集NSCLC患者(60名),健康体检者(60名)全血(EDTA抗凝处理),采用流式细胞术检测外周血淋巴细胞CD₃⁺,CD₄⁺,CD₈⁺T细胞百分比以及Th1和Th2细胞水平,并且用血细胞分析仪检测其淋巴细胞绝对值。结果 NSCLC术前和正常对照组CD₃⁺,CD₄⁺,CD₈⁺T细胞百分比(%)分别为58.40±10.27 vs 66.58±6.84,31.32±8.65 vs 39.40±6.43,34.23±8.00 vs 24.31±8.16,CD₄⁺/CD₈⁺比值为0.96±0.23 vs 1.58±0.23,差异均具有统计学意义(t=-6.726～14.916,P均<0.05)。NSCLC术后1～3天组和正常对照组CD₃⁺,CD₄⁺,CD₈⁺T细胞百分比(%)分别为56.31±8.00 vs 66.58±6.84,27.72±7.55 vs 39.40±6.43,33.69±7.10 vs 24.31±8.16,CD₄⁺/CD₈⁺比值为0.87±0.31vs 1.58±0.23,差异均具有统计学意义(t=-6.720～14.367,P均<0.05)。与正常对照组相比,NSCLC术后4～7天组CD4⁺T细胞百分比(%)为33.23±4.13 vs 39.40±6.43,差异具有统计学意义(t=6.257,P<0.05)。在辅助性T细胞亚群中,NSCLC术前与正常对照组Th1,Th2细胞含量(×10/μl)分别为6.79±1.34 vs 12.52±3.56,4.82±0.51 vs 2.32±0.82,Th1/Th2比值为1.39±0.84 vs 5.36±1.42,差异均具有统计学意义(t=-20.087～18.630,P均<0.05)。NSCLC术后1～3天组与正常对照组Th1细胞含量(×10/μl)为8.86±1.52 vs 12.52±3.56,术后4～7天组与正常对照组Th1细胞含量(×10/μl)为7.02±1.27 vs 12.52±3.56,差异均具有统计学意义(t=7.339～11.275,P均<0.05)。结论 NSCLC患者免疫功能紊乱,表现在T淋巴细胞数和辅助性T细胞的数量减少,T细胞亚群失调,明显趋向Th2细胞; 另外可能在癌细胞的不断刺激下,细胞免疫功能亢进杀伤性T细胞增多,经过手术治疗后杀伤性T细胞开始降低。

Content Variation of T Cells in Perioperative Patients with Non-Small Cell Lung Cancer

Objective To research the mechanism of the changes of T lymphocyte subtypes and provide reference for clinically prevention,diagnosis and treatment for NSCLC through analysis of the expression of Th1,Th2 in Non-small-cell carcinoma(NSCLC)patients.Methods Whole blood(EDTA anticoagulant treatment)from 60 NSCLC patients and 60 healthy subjects were collected to detect of the expression of CD₃⁺T cells,CD₄⁺Tcells and CD₈⁺T cells on T lymphocytes and the levels of Th1 and Th2 cellsby flow cytometer(FCM),and the absolute value of T lymphocyte by hematology analyzer.Results Compared with normal control group, after surgery 1～3 days NSCLC groups,the percent of CD₃⁺T,CD₄⁺T,CD₈⁺Tcells and the CD₄⁺/CD₈⁺ ratio in the NSCLC patients before surgery weresignificantly reduced 58.40±10.27 vs 66.58±6.84,31.32±8.65 vs 39.40±6.43,34.23±8.00 vs 24.31±8.16,0.96±0.23 vs 1.58±0.23(t=-6.726～14.916,P<0.05).The percent of CD₃⁺T,CD₄⁺T,CD₈⁺T cells and the CD₄⁺/CD₈⁺ ratio in the NSCLC patients after surgery 1～3 days werealso significantly decreased 56.31±8.00 vs 66.58±6.84,27.72±7.55 vs 39.40±6.43,33.69±7.10 vs 24.31±8.16,0.87±0.31 vs 1.58±0.23(t=-6.720～14.367,P<0.05).The percent of CD₄⁺T cells in the NSCLC patients after surgery 4～7 days was increased 33.23±4.13 vs 39.40±6.43(t=6.257,P<0.05).Compared with the control group,within the helper T cell subsets,the cell content of Th1,Th2 cells(×10/μl)and the Th1/Th2 ratio weresignificantly changed in different extent in the NSCLC group before surgery 6.79±1.34 vs 12.52±3.56,4.82±0.51 vs 2.32±0.82,1.39±0.84 vs 5.36±1.42(t=-20.087～18.630,P<0.05).The content of Th1 cells was lower inthe NSCLC patients after 1～3 days and 4～7 days 8.86±1.52 vs 12.52±3.56,7.02±1.27 vs 12.52±3.56(t=7.339～11.275,P<0.05).Conclusion The NSCLC patients presented immune dysfunction,like T lymphocytes and helper T cells decreased and Th2 cells were clearly in the ascendant.Also,the cytotoxic T cells increased by the stimulation of cancer cells,but they began to decrease after the surgery.