FOLFOX方案化疗对结直肠癌患者免疫细胞数的影响

背景与目的：化疗在杀伤肿瘤的同时,也损害了机体的正常免疫。很多文献曾报道晚期肠癌的化疗,常使细胞免疫功能抑制加重。本研究探讨FOLFOX方案即奥沙利铂联合亚叶酸钙及氟尿嘧啶联合化疗对结直肠癌患者免疫细胞数的影响及与健康人的差异。方法：80例结直肠癌患者行FOLFOX方案化疗（奥沙利铂85mg/m2,静脉滴注,第1天;亚叶酸钙200mg/m2,静脉滴注,第1天;氟尿嘧啶400mg/m2,第1天,2400mg/m2,持续静脉滴注46h）,2周1次,2次为1个疗程,采用流式细胞仪测定化疗前及化疗后2周、4周外周血T淋巴细胞亚群和NK细胞的活性,比较化疗前后的变化,同时根据临床分期进行亚组分析比较,以健康人作对照分析。结果：本组结直肠癌患者第1天、第2周及第4周外周血CD3＋、CD4＋、CD8＋、CD4＋/CD8＋及NK细胞活性比较均无显著下降（P〉0.05）,但患者外周血CD3＋、CD4＋、NK细胞数量及CD4＋/CD8＋比值与健康人相比下降,而CD8＋细胞比例显著升高,差异有显著性（P〈0.05）,提示免疫功能较健康人下降,而且外周血T淋巴细胞亚群和NK细胞数量的改变与结直肠癌临床病理分期有关,分期越晚,CD3＋、CD4＋及NK细胞数量CD4＋/CD8＋细胞比值越低,CD8＋细胞比例越高;Ⅰ、Ⅱ期结直肠癌患者与Ⅲ、Ⅳ期患者之间差异有显著性（P〈0.05）。结论：FOLFOX方案治疗结直肠癌疗效肯定,可改善患者生存质量,而且对机体免疫力影响小。检测淋巴细胞亚群对判断患者的免疫功能、预测肿瘤患者的预后以及指导临床是否需要应用免疫增强剂均有重要意义。

Effects of FOLFOX regimen chemotherapy on immunity of patients with colorectal cancer

Background and purpose: Anti-tumor chemotherapy compromises normal immune function of the patients. There were many reports that chemotherapy for advanced colorectal cancer often inhibit the cellular immune function. The effect of FOLFOX regimen chemotherapy on immunity of the patients with colorectal cancer before and after therapy was studied, and healthy people were used as a control. Methods: Eighty colorectal cancer patients were treated by FOLFOX regimen, which consisted of 2-hour infusion of oxaliplatin(85 mg/m~2) and 2-hour infusion of leucovorin (CF)(200 mg/m~2) on Day 1, followed by 5-fluorouracil(5-FU) bolus (400 mg/m~2) on Day 1 and 46-hour infusion (2 400 mg/m~2). FOLFOX regimen was repeated at 2-week intervals. Two treatments of the above regimen were defined as one cycle. Flow cytometry was used to detect T lymphocyte subsets and NK cells in blood samples from patients with colorectal cancer before and after therapy. Data obtained fi'om healthy people was used as control. Results: CD3~+, CD4~+ T cells, NK cells and CD4~+/CD8~+ ratio in blood samples were not significant before and after chemotherapy in first day, second week and fourth week(P0.05). Lower CD3~+, CD4~+ T cells, NK cells and CD4~+/CD8~+ ratio were detected in blood samples from cancer group than that from the healthy control(P<0.05). CD8~+ T lymphocyte were reverse. This change was related to the TNM pathological stage. Conclusion: FOLFOX regimen was effective for patients with coloreetal cancer, which can improve patients' life quality and did not impact on the immune function of the patients. The immune function of lymphocytes in peripheral blood of the patients with colorectal cancer was low, and even worse in the patients with late TNM stage. It is valuable for estimating the function of cell immune of the patients, patients prognosis and the role of immune therapy in the treatment of the patients by detecting T lymphocyte subset and NK cell.