摘要
目的：观察食管癌患者放疗前后免疫功能的动态变化，探讨与其相关的临床预后因素。方法选取2010年1月至2013年12月在南通大学第二附属医院放疗科就诊的食管癌放疗患者90例，分别于放疗前、放疗结束及放疗后3个月使用流式细胞仪检测患者外周血 T 淋巴细胞亚群及 NK 细胞比例，以30例本院健康体检者外周血人群为对照观察其变化。分析患者放疗前后免疫功能变化与临床特征及预后的关系。结果食管癌患者放疗前外周血 CD4^＋、CD8^＋、CD4^＋／CD8^＋比值、NK 细胞百分比分别为28．23％±8．22％、31．79％±7．61％、0．93±0．34、11．37％±4．57％，与对照组（36．03％±9．71％、27．26％±7．70％、1．34±0．27、15．31％±5．13％）相比，差异均有统计学意义（t ＝4．292，P ＝0．000；t ＝2．811，P ＝0．006；t ＝5．894，P ＝0．000；t ＝3．965，P ＝0．000）；放疗前外周血 CD3^＋细胞百分比为58．13％±9．46％，与对照组（60．06％±8．67％）相比，差异无统计学意义（t ＝0．998，P ＝0．325）。放疗后3个月免疫指标 CD3^＋（59．27％±9．92％）、CD4^＋（30．51％±9．04％）、CD8^＋（29．79％±6．98％）、NK 细胞（10．62％±4．43％）逐渐恢复到放疗前水平（t ＝0．789，P ＝0．431；t ＝1．769，P ＝0．079；t ＝1．837，P ＝0．068；t ＝1．113，P ＝0．267）。放疗后免疫功能改变（CD4^＋、CD8^＋、CD4^＋／CD8^＋、NK 细胞）与是否存在骨髓抑制（t ＝4．050，P ＝0．001；t ＝2．180，P ＝0．015；t ＝2．130，P ＝0．020；t ＝3．520，P ＝0．003）及照射体积大小（t ＝5．170，P ＝0．000；t ＝3．350，P ＝0．026；t ＝8．750，P ＝0．000；t ＝2．490，P ＝0．043）有关。生存分析显示：放疗后3个月免疫功能恢复良好的患者其中位生存时间优于恢复不良者（23个月∶17个月，χ^2＝6．820，P ＝0．009）。结论食管癌患者放疗前处于免疫功能抑制状态，放疗实施会进一步加重免疫抑制，其加重程度与骨髓抑制及照射体积相关；放疗后3个月患者免疫功能有所恢复，恢复良好者预后较好。
Objective To observe the dynamic changes of the immune function in patients with esophageal cancer during the radiotherapy and also to explore its association with the clinical prognosis factors. Methods Totally 90 cases with esophageal cancer received radiotherapy in Second Affiliated Hospital of Nan-tong University from January 201 0 to December 201 3 were collected.The proportions of T-lymphocyte subsets and natural killer （NK）cells in the peripheral blood were detected by the flow cytometry from start to finish and 3 months after radiotherapy.Meanwhile,30 cases of healthy subjects were taken as control.The changes of the immune function in the patients during the radiotherapy and the correlation between the changes and clinico-pathologic features were analyzed,as well as the clinical prognostic factors were further evaluated.Results The difference of proportions of CD4^＋ T cells （28.23% ±8.22%）,CD8^＋ T cells （31 .79% ±7.61 %）, CD4^＋/CD8^＋ ratio （0.93 ±0.34）and NK cells （1 1 .37% ±4.57%）in pre-radiotherapy patients with esopha-geal cancer were statistically significant （t =4.292,P =0.000;t =2.81 1 ,P =0.006;t =5.894,P =0.000;t =3.965,P =0.000）compared with control group （36.03% ±9.71 %,27.26% ±7.70%,1 .34 ±0.27, 1 5.31 % ±5.1 3%）;but the proportions of CD3^＋ T cells （58.1 3% ±9.46%）had no obvious difference （t =0.988,P =0.325）compared with control group （60.06% ±8.67%）.The immune function of esophageal＆amp;nbsp;patients in 3 months after radiotherapy such as CD3^＋（59. 27% ±9.92%）,CD4^＋（30.51% ±9.04%）, CD8^＋（29.79% ±6.98%）and NK cells （1 0.62% ±4.43%）gradually returned to the pre-radiotherapy levels （t =0.789,P =0.431 ;t =1 .769,P =0.079;t =1 .837,P =0.068;t =1 .1 1 3,P =0.267）.The changes of immune function （CD4^＋,CD8^＋,CD4^＋/CD8^＋ ratio,NK cells）after radiotherapy were related to the bone marrow suppression （t =4.050,P =0.001 ;t =2.1 80,P =0.01 5;t =2.1 30,P =0.020;t =3.520,P =0.003）and irradiation volumes （t =5.1 70,P =0.000;t =3.350,P =0.026;t =8.750,P =0.000;t =2.490,P =0.043）.Survival analysis showed that the patients whose immune function recovered better in 3 months after radiotherapy had a longer median survival time than those recovered bad （23 months vs. 1 7 months,χ^2 =6.820,P=0.009）.Conclusion The patients of esophageal cancer are immunosuppressive before radiotherapy and will further aggravated after radiotherapy.The degree of immunosuppression is associa-ted with bone marrow suppression and irradiation volumes.The immune function of patients are recov-ered in 3 months after radiotherapy,and the patients whose immune function recovered better have good prognosis.
作者
王小博
吴迪军
陈卫平
刘健
Wang Xiaobo Wu Dijun Chen Weiping Liu Jian(Department of Radiotherapy, Second Affiliated Hospital of Nantong University, Nantong 226001, China)
出处
《国际肿瘤学杂志》
CAS
2016年第12期886-891,共6页
Journal of International Oncology
