膀胱癌治疗前后淋巴细胞亚型分析及其意义

目的:研究膀胱癌患者治疗前后机体T细胞分化群状态及其与肿瘤侵袭、转移和复发的关系。方法：以20例良性疾病对照，应用流式细胞仪检测20例膀胱癌患者外周静脉血中CD3，CD4和CD8细胞亚群及CD4／CD8比例，应用方差分析及t检验，比较二者差异及临床意义。结果：膀胱癌患者术前，CD3，CD4亚型值和CD4／CD8比值明显低于对照组检测值（P＜0．05），而CD8值无明显差异（P＞0．05）。手术后，CD3，CD4及CD4／CD8值增高，但与对照组术后比较无统计学意义（P＞0．05），CD8值术后明显降低，与术前比较有显著性变化（P＜0．05）；化疗后CD3，CD4值降低，CD8值升高，与化疗前比较有显著性差异（P＜0．05）；与术前比较CD3，CD4变化无明显差异（P＞0．05），但CD8较术前升高，CD4／CD8低于术前（P＜0．05）。淋巴细胞CD3，CD4，CD8表型与膀胱癌病理分级，分期未见显著相关性，但1例M＋期肺转移患者CD3，CD4明显低于T2，T3期病例。复发癌组CD3，CD4，CD4／CD8低于未复发组（P＜0．05），而CD8高于未复发组（P＜0．05）。结论：膀胱癌患者存在有机体免疫功能低下状态，化疗有可能增加肿瘤免疫抑制作用，因此手术及化疗联合应用免疫增强剂对防治肿瘤具有重要意义。

Clinical Significance of Changes of T Lymphocyte Subset in Bladder Cancer Patients With Operation and Chemotherapy

Objective: Our aim was to evaluate the immunologic status of patients with bladder cancer. Methods: Three kinds of surface antigens, CD 3,CD 4, and CD 8, were measured by using flow cytometry in 20 cases. Results: Compared with 20 cases of benign disease in the controls, CD 3,CD 4,CD 4/CD 8 were significantly lower in cancer patients before operation (P<0.05). Though CD 3,CD 4,CD 4/CD 8 increased after operation, there was no difference between cancer patients and controls (P>0.05). After chemotherapy, lower CD 3 and CD 4 could be found ,and interestingly, CD 8 was higher than that in preoperation (P<0.05).Conclusion: The immunity of patients with bladder cancer are suppressed before operation, and chemotherapy may make it lower mainly by increasing CD 8. Combination of immunoenhancer and anticarcinogenic drugs in chemotherapy may be a more effective way to prevent and cure bladder cancer.