超声联合腹腔镜射频消融术对肝癌患者免疫功能的影响

目的观察肝癌患者经超声联合腹腔镜射频消融(laparoscopic radiofrequency ablation,LRFA)治疗前后外周血免疫指标的变化情况,评价腹腔镜射频消融治疗对机体免疫功能的影响。方法选取2011年3月至2012年3月本科室收治的肝癌患者62例,分为三组,A组为腹腔镜联合超声引导射频消融组(22例)、B组为经肝动脉化疗栓塞组(TACE组)(20例)、C组为外科手术组(20例),射频消融组采用超声引导联合腹腔镜射频消融治疗,手术组行肝癌根治术,20例健康献血员作为正常对照组。采用流式细胞术检测LRFA组治疗前后以及三组患者治疗前后同时相外周血中淋巴细胞亚群(CD3+、CD4+、CD8+、NK、CD19+)细胞的比例变化。结果 A、B、C三组患者治疗前外周血CD3+、CD4+数目、CD4+/CD8+比值、NK细胞数目明显低于正常对照组(P<0.01),CD8+较正常对照组稍有升高,但差异无显著性;A组治疗后1周,外周血CD3+、CD4+、NK数目、CD4+/CD8+比值较术前明显升高(P<0.05),CD8+数目显著下降(P<0.05),且术后第2周～第4周上述指标仍能维持在优于术前水平;B组治疗后1周,CD3+、CD4+、CD8+数目、CD4+/CD8+比值以及NK细胞数目较术前无明显变化,至术后第2周时CD3+、CD4+、CD4+/CD8+比值以及NK细胞数目显著高于术前(P<0.01);C组治疗后1周,CD3+、CD4+、CD8+、CD4+/CD8+比值较术前无明显变化,NK细胞数目显著低于术前,术后第2周、第3周上述指标有所改善,至术后第4周CD3+、CD4+数目、CD4+/CD8+比值以及NK细胞数目显著高于术前,而CD8+数目明显低于术前(P<0.05)。结论 LRFA治疗后1周内,患者机体的细胞免疫功能明显改善,而TACE及外科手术治疗后1周内,细胞免疫功能进一步受到抑制,至术后第2周行TACE治疗者细胞免疫功能较术前明显改善,行外科手术切除的患者需经过4周,细胞免疫功能尚能恢复。故三种治疗肝癌的方法中,对于细胞免疫系统功能的改善作用:LRFA>TACE>外科手术。

The Effects on Immunological Function of Patients with Hepatic Carcinoma Treated with Laparoscopic Radiofrequency Ablation Therapy Combined with Ultrasound

Objective To investigate the changes of immunological parameters and the immunity function of peripheral blood in patients with hepatic carcinoma after laparoscopic radiofrequency ablation therapy （LRFA） combined with ultrasound. Methods Sixty-two patients were divided into three groups： group A （22 cases） were treated with LRFA, group B （20 cases） were treated with transcatheter arterial chemoembolization, and group C （20 cases） were treated with radical operation. Those of healthy volunteers （20 cases） were considered as the control group. The percentage of lymphocyte subsets （CD3^＋ T cells, CD4^＋ T cells, CD8^＋ T cells, NK cells and CD19^＋ T cells） of peripheral blood were determined with flow cytometry before and after treatment. Results The percentages of CD3^＋, CD4＋, NK cells and the ratio of CD4^＋/CD8^＋of peripheral blood in the three groups of patients were significantly lower than those of the normal control group （P 〈0.01） while the percentage of CD8^＋ cell was slightly higher than that of the control group. After one week of the treatment, CD3^＋, CD4^＋ T lymphocyte, NK cells and the ratio of CD4^＋/CD8^＋ of group A were significantly higher than those on the preoperative day （P 〈0.05）, CD8＋ T lymphocyte was significantly lower than that on the preoperative day （P 〈0.05）, and 2 weeks to 4 weeks after treatment, the level of these indicators were able to maintain better than those before therapy. After one week of treatment, CD3^＋, CD4^＋, CD8^＋ T lymphocyte, NK cells and CD4~/CD8＋ of group B were not obviously different from those before therapy. After 2 weeks of treatment, CD3＋, CD4＋ T lymphocyte, NK cells and CD4＋/CD8＋ increased, with significant difference （P 〈0.01）. After one week of treatment, CD3^＋, CD4^＋, CD8^＋ T lymphocyte,and the ratio of CD4^＋/CD8^＋ of group C were not obviously different from those ofpreoperation, but the level of NK cell was significantly lower than that on the preoperative day. 2 to 3 weeks after surgery, these indicators had improved, 4 weeks after surgery, the number of CD3＋, CD4＋ T lymphocyte, NK cells and CD4＋/CD8＋ were significantly higher than those before treatment, CD8^＋ T lymphocytewas significantly lower than preoperation （P 〈0.05）. Conclusions The patient＇s cellular immune fimction is significantly improved one week after LRFA treatment. However, the patient＇s cellular immune function is further suppressed one week after TACE and surgical resection treatment. The cellular immune fimction of patients treated by TACE 2 weeks is significantly improved compared with preoperation. The cellular immune function of patients with surgical resection will be capable of recovery 4 weeks postoperatively. Therefore, the improvement of the three kinds of methods of treatment for liver cancer on the cellular immune system： LRFA〉TACE〉surgical resection.