全腔镜下手术对早期分化型甲状腺癌患者T细胞亚群及其细胞因子的影响

目的 探讨全腔镜下手术对早期分化型甲状腺癌患者T细胞亚群及其细胞因子的影响。 方法 自2013年1月—2015年1月，前瞻性收集收治的早期分化型甲状腺癌患者50例作为研究组，同期随机选取健康体检成人50例作为对照组。研究组给予全腔镜下甲状腺癌切除术。主要观察指标为2组研究对象外周血T细胞亚群及其细胞因子。 结果 与对照组比较，研究组CD4+T细胞比例显著降低[(20.48±6.43)% vs.(27.53±7.38)%,P=0.000]；CD4+/CD8+T细胞比例显著降低(0.63±0.12 vs.0.80±0.15,P=0.015)；IL-6水平显著降低[(20.73±5.39) ng/ml vs.(28.94±7.39) ng/ml,P=0.000]；IL-10水平显著升高[(45.39±15.62) ng/ml vs.(23.94±5.39) ng/ml,P=0.000]；TNF-α水平显著降低[(8.48±2.14) ng/ml vs.(13.58±3.49) ng/ml,P=0.000]。2组研究对象CD8+T细胞水平差异无统计学意义[(32.48±7.49)% vs.(34.58±8.12)%,P=0.463]。与术前比较，研究组术后CD4+T细胞显著增加[(24.82±3.32)% vs.(20.48±6.43)%,P=0.012]；IL-6显著增加[(20.48±6.43) ng/L vs.(20.73±5.39) ng/L,P=0.000]；IL-10显著降低[(38.59±9.83) ng/L vs.(45.39±15.62) ng/L,P=0.002]；TNF-α显著升高[(11.75±3.29) ng/L vs.(8.48±2.14) ng/L,P=0.000]。 结论 早期分化型甲状腺癌患者可呈免疫抑制状态，全腔镜下手术有助于改善早期分化型甲状腺癌患者免疫功能。 

The influence of total laparoscopic surgery on T cell subsets and its cytokines in patients with early differentiated thyroid cancer

Objective To investigate the effects of total laparoscopic surgery on T cell subsets and its cytokines in patients with early stage differentiated thyroid carcinoma. Methods From January,2013 to January,2015,we prospectively collected 50 cases with early differentiated thyroid cancer admitted to our hospital as the study group,and during the same period,50 healthy adults admitted to our hospital for health examination were randomly selected as the control group.The study group was given total endoscopic resection of thyroid carcinoma.The main outcome measures were the peripheral blood T cell subsets and their cytokines in the two groups. Results When compared with the control group,the proportion of CD4+T cells in the study group was significantly decreased[(20.48±6.43)% vs. (27.53±7.38)%,P=0.000];the proportion of CD4+/CD8+T cells was significantly decreased[(20.73±5.39)% vs. (28.94±7.39)ng/ml,P=0.000];the level of IL-6 was significantly decreased[(20.73±5.39)ng/ml vs. (28.94±7.39)ng/ml,P=0.000];IL-10 level increased significantly[(45.39±15.62)ng/ml vs. (23.94±5.39)ng/ml,P=0.000];the TNF-α was significantly lower[(8.48±2.14)ng/ml vs. (13.58±3.49)ng/ml,P=0.000].The levels of CD8+ T cells between the two groups had no statistical significance[(32.48±7.49)% vs. (34.58±8.12)%,P=0.463].Postoperative CD4+T cells in the study group were significantly increased[(24.82±3.32)% vs. (20.48±6.43)%,P=0.012];IL-6 was significantly increased[(20.48±6.43)ng/L vs. (20.73±5.39)ng/L,P=0.000];IL-10 was significantly decreased[(38.59±9.83)ng/L vs. (45.39±15.62)ng/L,P=0.002];the TNF-α was significantly higher[(11.75±3.29)ng/L vs. (8.48±2.14)ng/L,P=0.000]. Conclusion Patients with early differentiated thyroid cancer can be immunosuppressed,and total laparoscopic surgery is helpful to improve the immune function of early differentiated thyroid cancer patients.