肝脏恶性肿瘤射频消融术后并发症及细胞免疫功能特点

目的分析不同大小肝脏恶性肿瘤射频消融术治疗后并发症的发生及细胞免疫功能的变化情况。方法选取2013年1月-2015年1月间在湖南省人民医院介入科行射频消融术(RFA)治疗的69例肝脏恶性肿瘤病人,其中男52例,女17例,年龄37~76岁,平均(48.92±11.29)岁。选取23名2015年1月在本院接受健康体检者作为对照组,其中男17名,女6名,年龄37~76岁,平均年龄(48.02±11.14)岁。根据病人肿瘤灶的直径将病人划分为3组:组1(直径<3.0 cm)、组2(直径3.0~5.0 cm)、组3(直径>5.0 cm)。采用χ~2检验比较3个疾病组病人疗效及治疗后并发症发生情况,采用t检验比较疾病组术前与对照组间、疾病组治疗前后的肿瘤标志物甲胎蛋白(AFP)表达水平,采用方差分析对对照组、疾病组RFA术前及术后3组间的淋巴细胞亚群细胞计数进行组间比较,并采用Pearson相关分析AFP与淋巴细胞亚群的相关性。结果 3个疾病组之间完全和部分消融率差异均有统计学意义(均P<0.05)。3组间RFA治疗后不同程度并发症发生率差异均无统计学意义(均P>0.05)。疾病组RFA术前、术后的AFP水平均高于对照组,疾病组RFA术后AFP水平低于术前,其差异均有统计学意义(均P<0.05)。疾病组RFA术前CD3^+、CD4^+、CD8^+、CD4^+/CD8^+、NK细胞低于术后及对照组(均P<0.05);术后与对照组比较差异均无统计学意义(均P>0.05)。AFP与CD3^+、CD4^+、NK细胞呈负相关而与CD8^+细胞呈正相关(均P<0.05);AFP与CD19^+细胞虽然呈负相关趋势,但相关性无统计学意义(P>0.05)。结论 RFA可有效提高肝脏恶性肿瘤病人细胞免疫功能,且术后严重并发症发生率低,值得在不耐受切除手术治疗的肝脏恶性肿瘤病人中推广应用。

The postoperative complications and cellular immune function features in patients with hepatic malignancy after radiofrequency ablation

Objective To analyze the incidence of complications and the changes of cellular immune function after radiofrequency ablation of different sizes of hepatic malignancyliver malignant tumors. Methods Sixty-nine patients with hepatic malignancies who underwent radiofrequency ablation (RFA) in the Interventional Department of the Hunan Provincial People’s Hospital from January 2013 to January 2015 were enrolled in this study. There were 52 males and 17 females, with an average age (48.92 + 11.29).The patients were divided into three groups according to the diameter of the tumors.:Group 1 (diameter < 3.0 cm), group 2 (3.0-5.0 cm in diameter), group 3 (diameter > 5.0 cm), Compare the three groups of patients curative effect and complications after treatment, statistics all patients before and after treatment of 4 weeks of the tumor markers AFP (AFP), lymphocyte subgroup cell count and comparison analysis, and analysis of the correlation. The clinical data of AFP and Lymphocyte subsets were analyzed before and after the treatment, and the correlation between them was also analyzed. Twenty-three patients who received physical examination in our the Hunan Provincial People’s Hospital hospital in January, 2015 were selected as the control group. Among them, 17 males and 6 females, average age (48.02 + 11.14). Results The complete ablation rate of group 1, group 2 and group 3 was 93.10%, 66.67% and 14.29% respectively, and the complete ablation rates of the three groups were statistically significant, P < 0.01.There was no statistical difference in postoperative complications of the three groups, P> 0. 05;The AFP of RFA preoperative disease group was significantly higher than that in the control group, and postoperative disease group AFP significantly lower than preoperative period, all P < 0.01. The CD3+, CD4+, CD8+, CD4+/CD8+ and NK cells in the pretreatment group were significantly different from those in the control group, P < 0.01;The ratio of NK cells, T cells CD3+, CD4+ , CD8+ and CD4+/CD8+ in the pretreatment group were significantly different from those in the posttreatment group.AFP was significantly negatively correlated with NK cells, CD4+ cells, and CD3+ cells, and significantly positively correlated with the CD8+ cells,P < 0.05.The complete ablation rate was 93.10%, the complete ablation rate of tumor diameter was 3.0 ~ 5.0cm was 66.67%, the complete ablation rate of tumor diameter＞＞ 5.0cm was 14.29%, the complete ablation rate of the three groups was significantly different Sex, P ＜0.01. There was no significant difference in the incidence of postoperative complications among the three groups (P＞＞ 0.05). The AFP of RFA preoperative group was significantly higher than that of the control group (P ＜0.01) and the AFP of the disease group was significantly lower than that before treatment (P ＜0.01). The ratio of CD3 +, CD4 +, CD8 +, CD4 + / CD8 +, NK cells in the disease group before treatment was significantly different from that in the control group (P ＜0.01). The ratio of CD3 +, CD4 + and CD8 + (P ＜0.01), CD19 + cells had statistically significant difference compared with before treatment (P ＜0.05). AFP was negatively correlated with NK cells, CD4 +, CD3 + cells and CD3 + cells, but there was no significant correlation between AFP and CD19 + cells (-1) (r ＜0, P ＜ AFP was positively correlated with CD8 + cells, 0 ＜r ＜1, P ＜0.05. Conclusion RFA can effectively improve the cellular immune function of patients with hepatic malignancyhepatocellular carcinoma, and the incidence of serious postoperative complications iswas low. It is worthy to be popularized in hepatic malignancymalignant liver cancer patients who can not tolerate surgical resection.