肝细胞肝癌病人Th1/Th2免疫评估

目的 通过检测135例原发性肝癌（PLC）患者手术前后血清IL-2、IL-4、IL-10、IFN-γ、肿瘤坏死因子（TNF）-α水平,并与30例健康查体者（对照组）进行对照分析,观察肝细胞癌病人免疫功能改变并进一步结合临床病理学指标,分析免疫功能变化对临床诊断的指导意义.方法 肝癌病人在术前和术后10d、20d、30d抽取清晨空腹静脉血,对照组在体检合格后抽取空腹静脉血,ELISA技术检测血清IL-2、IL-4、IL-10、IFN-γ、肿瘤坏死因子（TNF）-α浓度.结果 肝癌患者IL-2含量平均为98.2pg/ml,较对照组明显降低（p〈0.05）;IL-4、IL-10含量肝癌组为114.8±27.3 pg/ml和65.6 pg/ml,均明显高于正常对照组（p〈0.01）; TNF-α、IFN-γ血浆含量在肝癌组分别为153.3 pg/ml和89.0 pg/ml,与正常对照组比较均具有显著差异（P〈0.01）.IL-2、TNF-α血清含量在Ⅱ、Ⅲ期肝癌患者均低于Ⅰ期（p〈0.01）,IL-4、IL-10 血浆含量随着病情进展逐渐升高,呈现III期〉II期〉I期趋势,其差异具有显著意义;PHCⅡ、Ⅲ期患者IFN-r含量与Ⅰ期患者间比较差异有显著性.手术后 IL-2、IFN-γ、TNF-α呈逐渐升高趋势,术后20天起血浆浓度与术前血浆浓度相比即具有明显差异（p〈0.05）,术后30天即基本接近正常水平,与术前、术后10天相比具有显著统计学意义（p〈0.05）;IL-4、IL-10呈现逐渐降低趋势,术后20天、术后30天与术前相比其差异具有显著统计学意义（p〈0.05,p〈0.01）.结论 肝癌病人免疫功能失衡,出现Th1/Th2漂移,表现为IL-2、IL-4、TNF-α、IFN-γ、IL-4、IL-10等指标明显改变,并且与肿瘤的分期有关,可作为判断肿瘤分期指标之一.手术切除肿瘤在一定程度上可促进患者免疫失衡的恢复,但手术、麻醉等大的损伤可进一步加重病人的免疫失衡,故不能完全切除病灶者,手术适应症的选择需慎重.

Evaluation of Th1/Th2 Immune Functions in Hepatoma Patients

Objective To examine the immune alternation of primary hcpatocyte cancer by testing IL - 2, IL - 4,1L - 10, IFN - γ, TNF - a serum concentration in 98 cases of PHC patients ; and to analyse the results combined with clinnicipathologic characteristics, aim to investigate the diagnosis value. Methods Before and after surgical oppration 10,20,30 days, IL- 2, IL- 4, IL- 10, IFN- γ,TNF- α serum level wet examine by ELISA assay. Results The data showed that IL- 2, TNF- α,IFN- γ serum level were lower and IL- 4,IL- 10 level were higher in PHC patients than that in control group, and significant differences were found too（ P 〈 0.05 ）. In II, III stage patients IL- 2 and TNF-α were lower than in I stage patients （p 〈 0.01 ）. IL- 4, IL- 10 concentrations increased accordante to the state of illness, a crescent thrend that III stage 〉 II stage 〉 I stage was found. And there were significant differences between the IFN - r level in II, III stage and I stage PHC too. Ten days after excision, IL - 2, IFN - γ plasima level rised up gradually. 20 days later, the levels were higher than before excision（ p 〈 0. 05） and which came back to normal level 30 days later. IL- 4, IL- 10 concentration decreased gradeually, differences were found between samples that after excision 20,30 days and samples before opration（p 〈 0.05 ,p 〈 0.01）. TNF- α, which increased alter operation. Conclusions IL- 2, IL- 4, TNF - α, IFN - γ, IL- 4, IL- 10, ICAM - 1 serum concentration changed significantly in PHC patients, and that is related to the stage of tumor. Surgical excision can promote the rebalance of immunical function in PHC patients in a degree, but operation also could aggravate immunical function imbalancement, so operation should be considerable to the cases that can not resect tumor thoroughly.