晚期消化道肿瘤患者化疗前后T细胞亚群的变化

背景与目的:肿瘤患者免疫功能低下,对其进行化疗将进一步抑制其机体的免疫系统。因此,合理的免疫调节将是对肿瘤患者重要的辅助治疗手段。本研究旨在检测消化道肿瘤患者化疗前后外周血T细胞亚群及相关细胞因子IL-2的变化规律,研究化疗及化疗后不同反应患者机体免疫功能状态的改变,并探讨对晚期消化道肿瘤患者进行适时、合理免疫治疗的临床意义。方法:采用流式细胞仪检测(flow cytometry,FCM)分析2005年9月至2006年4月苏州大学附属第一医院收治的104例消化道肿瘤患者化疗前后外周血中CD3 、CD4 、CD8 、CD4 CD28 、CD8 CD28 和CD4 CD25 T细胞百分数;采用酶联免疫吸附实验(enzyme-linked immunosorbent assay,ELISA)检测其血浆相关细胞因子IL-2的表达水平。结果:消化道肿瘤患者组CD4 、CD4 CD28 、CD8 CD28 和CD4 CD25 T细胞百分数及CD4/CD8比值分别为(36.52±3.85)%、(32.87±4.98)%、(6.87±3.11)%、(9.68±3.42)%、0.98±0.17;对照组各指标分别为:(45.23±9.20)%、(40.12±5.85)%、(15.8±4.50)%、(5.67±2.90)%、1.43±0.12。晚期消化道肿瘤化疗有效组。化疗前CD4 CD28 和CD8 CD28 T细胞百分数及CD4/CD8比值分别为:(22.93±3.98)%、(7.08±1.23)%、0.90±0.22,化疗3周后,各指标分别为(28.25±4.03)%、(12.10±3.45)%、1.24±0.22;化疗无效组,化疗前CD4 CD28 、CD8 CD28 和CD4 CD25 T细胞百分数分别为(24.08±4.02)%、(6.35±1.23)%、(8.20±2.34)%,化疗3周后,各指标分别为(16.45±3.27)%、(3.20±0.82)%、(20.34±3.69)%。结论:晚期消化道肿瘤患者化疗1～2周后加重了免疫抑制的程度,化疗有效组患者化疗3周后全身免疫状况改善;而化疗无效组未出现相应的免疫功能的改善,甚至免疫功能进一步恶化。

Influence of intravenous chemotherapy on cellular immunity in patients with advanced digestive tract cancer

BACKGROUND & OBJECTIVE: Cancer patients have a poor immune response and chemotherapy could deteriorate their immune system further. Reasonable immune therapy is an important adjuvant remedy for tumors. This study was to monitor the changes of T-cell phenotypes in peripheral blood and interleukin-2 (IL-2) concentration in plasma in digestive tract cancer patients before and after chemotherapy. METHODS: The proportions of CD3+, CD4+, CD8+, CD4+CD28+, CD8+CD28+ and CD4+CD25+ T cells in peripheral blood of 104 patients with advanced digestive tract cancer, hospitalized from Sep. 2005 to Apr. 2006, were detected by flow cytometry (FCM). The concentration of IL-2 in plasma was measured by ELISA. RESULTS: The proportions of CD4+, CD4+CD28+, CD8+CD28+, CD4+CD25+ T cells and ratio of CD4/CD8 were (36.52+/-3.85)%, (32.87+/-4.98)%, (6.87+/-3.11)%, (9.68+/-3.42)% and 0.98+/-0.17 in digestive tract cancer patients, and (45.23+/-9.20)%, (40.12+/-5.85)%, (15.8+/-4.50)%, (5.67+/-2.90)% and 1.43+/-0.12 in healthy subjects. In the patients with response to chemotherapy, the proportions of CD4+CD28+ and CD8+CD28+ T cells and ratio of CD4/CD8 were (22.93+/-3.98)%, (7.08+/-1.23)% and 0.90+/-0.22 before chemotherapy, and (28.25+/-4.03)%, (12.10+/-3.45)% and 1.24+/-0.22 at 3 weeks after chemotherapy. In the patients with no response to chemotherapy, the proportions of CD4+CD28+, CD8+CD28+ and CD4+CD25+ T cells were (24.08+/-4.02)%, (6.35+/-1.23)% and (8.20+/-2.34)% before chemotherapy, and (16.45+/-3.27)%, (3.20+/-0.82)% and (20.34+/-3.69)% at 3 weeks after chemotherapy. CONCLUSIONS: The immunosuppression of digestive tract cancer patients would be enhanced early (about 1-2 weeks) after intravenous chemotherapy. The immunity of the patients with response to chemotherapy would be improved at 3 weeks after chemotherapy; while the immunity of the patients with no response to chemotherapy would not change, or even be suppressed.