肾癌术后免疫治疗T细胞亚群检测及疗效观察

目的:检测肾癌术后患者IL-2免疫治疗前后对外周血T淋巴细胞亚群的水平影响，进一步观察其对肾癌术后患者的疗效。方法:肾癌术后患者98例随机分为两组:实验组58例采用IL-2治疗，皮下注射小剂量（60-100万IU/次），隔日1次，共3月,以后每年方案同前1年。对照组40例只给予肾癌根治术，不予免疫治疗。应用流式细胞技术检测两组患者不同时间段（治疗前，治疗后2月、6月）外周血CD3+、CD4+、CD8+、CD4+/CD8+，并进行对比研究。观察两组治疗后1年、3年生存率、生活质量(KPS)评分以及不良反应。结果:实验组与对照组CD3+、CD4+、CD4+/CD8+在治疗前无明显差异(P＞0.05)，治疗后2月、6月较对照组明显升高(P＜0.05)。术后1年实验组生存率100％(58/58)，对照组97.5%（39/40）,两者无明显差异(P＞0.05)；术后3年实验组生存率84.5％（49/58），明显高于对照组（67.5%，27/40)(P＜0.05)。实验组术后1年生活质量评分平均升高19.6分，3年生活质量评分平均升高11.5分，均明显高于对照组3.7分、1.4分(P＜0.05)。实验组不良反应共12例，均为一过性，未影响免疫治疗。对照组无相关不良反应。结论:肾癌根治术后应用IL-2进行免疫治疗，可以提高患者免疫水平，发挥抗肿瘤作用，提高生存率，改善生活质量，不良反应较轻。

T cell-subsets dectation and effect observation on immunotherapy in postoperative renal cell carcinoma

Objective:To detect T cell-subsets and observe the effect of IL-2 immunotherapy in postoperative renal cell carcinoma.Methods:All 98 cases of postoperative renal cell carcinoma were randomly divided into two groups:Experimental group (58 cases) were treated with IL-2,subcutaneous injection of small dose (600-1000k IU),once every other day for 3 months，the next year programme as previous;Control group (40 cases) were only given radical nephrectomy,without immune therapy.Peripheral blood CD3+,CD4+,CD8+,CD4+/CD8+ were dectated in two groups with different times(before treatment,2months after treatment,6months after treatment).Survival rates,quality of life (KPS) score and adverse reaction were observed.Results:There were no significant differences in CD3+,CD4+,CD4+/CD8+ between two groups before treatment (P＞0.05).Experimental group were higher than those of control group 2months and 6months after treatment(P＜0.05).Experimental group survival rate was 100% after 1 year(58/58).Control group was 97.5%(39/40),there was no significant difference(P＞0.05).Experimental group survival rate was 84.5% after 3 years (49/58),which was significantly higher than that of control group 67.5%(27/40)(P＜0.05).Quality life score increased by an average of 19.6 in experimental group 1 year postoperation and 11.5 3 years later,which were significantly higher than control group (P＜0.05).A total of 12 cases of adverse reactions in experimental group,which were transient;there was no related adverse reaction in control group.Conclusion:Application of IL-2 immune postoperation therapy can improve the immunity level,exert antitumor effects,increase survival rate and improve the quality of life with less side effects.