冷冻消融联合栓塞治疗对中晚期肾癌细胞免疫功能的影响  

Effect of transcatheter renal arterial embolization combined with cryoablation on regulatory CD4 ＋ CD25 ＋ T lymphocytes in the peripheral blood of patients with advanced renal carcinoma

作　　者：刘长富[1] 郭志[1] 司同国[1] 邢文阁[1] 刘方[1] 邢纪中[1] 

机构地区：[1]天津医科大学附属天津肿瘤医院肿瘤介入治疗科天津市肿瘤防治重点实验室,300060

出　　处：《中华医学杂志》2010年第13期902-905,共4页National Medical Journal of China

基　　金：基金项目：国家十一五科技支撑计划（2007BA105806）

摘　　要：目的分析氩氦冷冻消融联合肾动脉栓塞（TRAE）治疗对中晚期肾癌患者外周血CD4＋CD25＋调节性T细胞（regulatoryTcell，Treg）的影响及临床意义。方法回顾我院77例中晚期肾癌患者临床资料，依据接受治疗方式分为两组：冷冻消融联合TRAE治疗组32例；单纯TRAE组45例。分别于治疗前、后3个月取外周血，流式细胞仪检测外周血Treg及T淋巴细胞亚群；术后1个月采用增强MRI或cT评价肿瘤坏死程度。结果联合组治疗后Treg细胞占CD4＋T细胞比例由6．6％±1．2％下降至3．9％±1．2％，二者差异具有统计学意义（t=42．768，P〈0．01）；CD4＋T、CD8＋T细胞比例及CD4＋T／CD8＋T较术前明显增高，差异均具有统计学意义（均P〈0．01）。而TRAE组治疗前后Treg细胞占CD4＋T细胞比例、CD4＋T、CD4＋T／CD8＋T、CD8＋T细胞比例虽略有增高但差异均无统计学意义（均P〉0．05）。联合组的肿瘤坏死率为57．5％，单纯TRAE组为31．6％，两组比较，差异具有统计学意义（t=6．784，P〈0．01）。联合组中位生存期为（20个月），明显高于TRAE组（12个月），二者差异具有统计学意义（x。=7．368，P〈0．01）。相关性分析显示：治疗后Treg细胞比例下降程度与肿瘤坏死率（r=0．90P〈0．01）及生存期（r=0．67P〈0．01）呈密切正相关关系。结论TRAE与冷冻消融联合治疗中晚期肾癌能明显降低Treg细胞比例，改善患者免疫状态，可提高肿瘤坏死率并延长患者生存期。Objective To analyze the effect of Argon-Helium cryosurgery （AHCS） combined with transcatheter renal arterial embolization （TRAE） on the differentiation of regulatory CD4 ＋ CD25 ＋ T cell （Treg） and its implication in patients with renal carcinoma. Methods 77 patients were called in the study, and were devided into two groups ： TRAE group （ n = 45, receiving TRAE only） and TRAE ＋ cryoablation group（ n = 32, receiving cryoablation 2--3 weeks after TRAE ）. The percentage of Treg cells and T lymphocyte subsets （CD3＋ T, CD4＋ T, CD8＋ T, and CD4＋ T/CD8＋ T） in the peripheral blood was measured by flow cytometry before and 3 months after therapy. Meanwhile, the extent of tumor necrosis was mesured by MRI or CT 1 month after therapy. Results The percentages of Treg ceils of patients in TRAE ＋ cryoablation group were decreased from 6. 6% ±1.2% to 3.9% ±1.2%, （ t = 42. 768, P 〈 0. 01 ）, and the percentages of CD3 ＋ T, CD4＋ T, CD8 ＋ T, NK and CD4 ＋ T/CD8 ＋T were significantly increased （P 〈 0.01 ）. However, among the patients in TRAE group, the percentages of Treg , CD3 ＋ T, CD4 ＋ T, CD8 ＋ T, NK and CD4 ＋ T/CD8 ＋ T were increased （ P 〉 0. 05 ）. The tumor necrosis rates of TRAE ＋ cryoablation groups were 57.5%, significantly higher than those of TRAE group, which shows 31.6% （t = 6. 784,P 〈 0.01 ）. The median survival duration of the TRAE ＋ cryoablation group was 20 months, significantly longer than that of the TRAE group （ x2 = 7. 368, P 〈 0. 01 ）. The decreasing extent of Treg cells is correlated with tumor necrosis rates（r =0.90 P〈0.01）and life time（r =0.67 P〈0.01）. Conclusion The therapy of TRAE combined with cryoablation contributed to reduce the percentage of Treg ceils and improve the immunesituation of patients with renal cell carcinoma, consequently increase tumor necrosis rate and prolongs the patients＇ survival duration.

关 键 词：肾肿瘤 冷冻 冷冻外科手术 

分 类 号：R737.11[医药卫生—肿瘤]