肺癌患者外周血 T- 淋巴细胞亚群 NK 细胞的基线数值及其与预后的关系*

目的:对比肺癌患者与健康者之间淋巴细胞亚群差异，评估肺癌患者外周血T 淋巴细胞亚群及自然杀伤细胞（NK）之基线值与预后的关系。方法:收集2006年2 月至2013年3 月就诊于天津医科大学肿瘤医院病例资料完整的肺癌患者105 例，其中非小细胞肺癌（NSCLC ）86例、小细胞肺癌（SCLC）19例，另选健康对照35例，对比接受治疗前肺癌患者和健康对照者外周血中的CD3+T 细胞、CD4+T 细胞、CD8+T 细胞及NK细胞所占百分比，并回顾性分析86例NSCLC 患者初治时外周血淋巴细胞亚群与预后的关系。结果:肺癌患者外周血CD3+T 细胞、CD4+T 细胞、NK细胞及CD4/CD 8 比值均明显低于健康对照组（P = 0.011，P = 0.007，P <0.001，P=0.025），而CD8+T 细胞比例高于健康对照组（P = 0.013）。 当CD8+T ≥ 31.8% 及CD4/CD 8< 1.28时NSCLC 患者可以获得一个更长的OS（中位OS分别为36.2 m vs . 20.0 m ，P = 0.010；30.8 m vs . 20.0 m ，P = 0.035）。 而CD3+T 细胞、CD4+T 细胞及NK细胞百分比对NSCLC 患者预后无显著影响。结论:外周血CD8+T 细胞基线水平较高的NSCLC 患者生存较长，此基线水平可能对NSCLC 患者预后有指示作用。 

Base amount of blood T-lymphocyte subsets and NK cells in patients with lung cancer and its value in predicting prognosis

Objective: To predict survival outcome, the lymphocyte subsets between lung cancer patients and healthy subjects was compared, and the significance of T-lymphocyte subgroups and NK cell base amount in the peripheral blood of lung cancer patients was evaluated. Methods:The percentage of CD3+T, CD4+T, CD8+T, and natural killer (NK) cells in the peripheral blood of 105 patients with lung cancer and 35 healthy subjects were analyzed by flow cytometry. Among the 105 patients, 19 cases were small cell lung can-cer (SCLC) and 86 cases were non-small cell lung cancer (NSCLC). The lymphocyte levels of the subgroups were recorded, and the rela-tionship between lymphocyte subsets of 86 NSCLC patients and survival outcome was analyzed retrospectively. Results:The levels of CD3+, CD4+, NK cells and the ratio of CD4/CD8 in patients have respective P values of 0.011, 0.007,<0.001, 0.025, which were signifi-cantly lower than that in normal subjects. However, the proportion of CD8+increased remarkably in patients (P=0.013). The overall sur-vival (OS) was more longer when CD8+T were≥31.8%of NSCLC patients, and the ratio of CD4/CD8 were less than 1.28 of NSCLC pa-tients (mean OS 36.2 m vs. 20.0 m, P=0.010;30.8 m vs. 20.0 m, P=0.035, respectively). However, the percentage of CD3+, CD4+, and NK cells had an insignificant effect in predicting the prognosis of NSCLC patients. Conclusion:High basal levels of CD8+T cells in peripheral blood could prolong the survival of patients with NSCLC. Furthermore, evaluating the basal levels of CD8+T cells by flow cytometry in peripheral blood might provide prognostic information.