晚期消化道肿瘤患者化疗前后外周血血浆细胞因子的变化

目的检测消化道肿瘤患者化疗前后血浆细胞因子的变化，从而探讨化疗对不同患者机体免疫状态改变的影响及其临床意义。方法采用ELISA方法检测健康组、消化道肿瘤组、早期消化道肿瘤组及晚期消化道肿瘤组患者化疗前后血浆细胞因子的变化。结果消化道肿瘤患者组IL-2的水平显著低于健康组（P〈0．05），而其IL-10和TNF-α水平略高于健康组（P〉0．05），以上结果与临床分期有关，即晚期患者IL-2较早期患者更低（P〈0．05），而IL-10和TNF-α则较早期患者更加升高。晚期消化道肿瘤患者化疗后1周，血浆IL-2浓度较化疗前明显下降，处于极低水平，其中化疗无效组降低更为明显。化疗后2周起，化疗有效组患者IL-2浓度逐渐回升并接近化疗前水平，化疗后3周其水平甚至显著超过化疗前水平（P〈0．05）；而化疗无效组，IL-2浓度虽有微弱回升但仍明显低于化疗前。血浆中IL-10和TNF-α的浓度却在化疗后呈现一个先增高后减低的趋势。结论消化道肿瘤患者机体免疫功能受到抑制，而且免疫抑制程度与其临床分期有关，早期患者的免疫抑制程度较轻，晚期患者的免疫抑制程度较重。晚期消化道肿瘤患者化疗后早期（1～2周）加剧了免疫抑制的程度，化疗有效患者，化疗后3周全身免疫状况改善；而化疗无效组未出现相应的免疫功能的改善，甚至呈现免疫功能的进一步恶化。

Influence of Intravenous Chemotherapy on Cytokine in Peripheral Blood Plasma in Patients with Advanced Digestive Tract Cancer

Objective 　To investigate the change of cytokines in plasma af ter int ravenous chemotherapy in patient s with digestive t ract cancer and to discuss it s clinical significance. Methods 　Using EL ISA meth2 od , we assessed the change of cytokines in plasma in patient s with digestive t ract cancer af ter chemother2 apy. Results 　Cytokines in plasma in patient s with digestive t ract cancer showed that the concent ration of IL22 was decreased with statistical significance in patient s with digestive t ract cancer compared with nor2 mal person , while the concent ration of IL210 and TNF2αcould be higher than those of normal person and without statistical significance. All the variations were related with clinical stage of tumor. One week af2 ter int ravenous chemotherapy in effective patient s with advanced digestive t ract cancer , the concent ration of IL22 was significantly decreased ; two weeks later , the concent ration of IL22 was recovered and closed to normal level ; three weeks later , it was even higher than the concent ration before chemotherapy. IL22 of patient s in non2effective group was slightly increased af ter chemotherapy but still lower than before. All the variations of IL210 and TNF2α af ter chemotherapy were showed the t rend declined af ter rising first . Conclusion 　Patient s with advanced2stage cancer have a poor immune response which was related with clinical stages of tumor. Af ter int ravenous chemotherapy , in early stage (about 122 weeks) patient s were both in an immunosuppressant state. While three weeks later , patient s with different result s showed different immune states. It may be followed by“rebound2overshoot”recovery of immune function in patient s with favorable clinical course.