化疗栓塞联合冷冻对肝癌患者免疫功能的影响  

Effects of transcatheter arterial chemoembolization (TACE) combined with cryoablation on immunologic function in patients with advanced primary hepatocellular carcinoma

作　　者：杨茂[1] 郭志[1] 司同国[1] 邢文阁[1] 李保国[1] 刘方[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,天津肿瘤防治重点实验室,天津300060

出　　处：《放射学实践》2011年第5期534-537,共4页Radiologic Practice

基　　金：国家十一五科技支撑计划课题资助项目(2007BAI05B06)

摘　　要：目的:探讨肝动脉化疗栓塞(TACE)联合冷冻消融对中晚期肝癌患者免疫功能的影响及临床意义。方法:搜集59例中晚期原发性肝细胞癌(经影像学检查显示无远处转移)患者资料,依据接受治疗方式不同分为两组:TACE联合冷冻消融治疗组27例为研究组;单纯接受TACE 32例为对照组;研究组在TACE术后2～3周行冷冻消融术。两组分别于治疗前1周、治疗后1月取外周血,测定AFP、T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+、Treg)水平变化;术后1个月采用增强CT、MRI评价肿瘤坏死程度。结果:两组治疗后甲胎蛋白(AFP)均下降,差异均具有统计学意义(P<0.01)。研究组肿瘤坏死率(53.9%)较对照组(32.8%)高,差异具有统计学意义(P<0.01)。研究组调节T细胞(Treg细胞)比例由(8.43±2.58)%下降至(7.33±2.56)%,治疗前后差异具有统计学意义(P<0.01);CD3+、CD4+细胞比例及CD4+/CD8+分别由(49.07±6.59)%、(46.51±8.17)%、1.23±0.32上升至(52.16±6.44)%、(50.63±8.27)%、1.52±0.46,治疗前后差异均具有统计学意义(P<0.01);CD8+由(39.15±6.54)%下降至(34.79±6.16)%,治疗前后差异具统计学意义(P<0.01)。对照组治疗后Treg细胞、CD8+比例略有增加,CD4+细胞比例及CD4+/CD8+略有下降,但治疗前后差异均无统计学意义(P>0.05)。结论:TACE联合冷冻消融治疗中晚期肝癌能提高肿瘤坏死率,降低Treg细胞比例,改善患者细胞免疫抑制状态,增强机体的抗肿瘤免疫效应。Objective：To investigate the effect of transcatheter arterial chemoembolization（TACE） combined with cryoablation on the immunologic function of patients with advanced primary hepatocellular carcinoma（HCC）.Methods：A total of 59 cases of HCC without metastasis in radiological examination were divided into the study group（27 patients treaed with cryoablation after TACE） and the control group（32 patients treated only with TACE）.The levels of AFP and T lymphocyte subsets cell（CD3^＋,CD4^＋,CD8^＋,CD4^＋/CD8^＋,Treg） in peripheral blood of HCC patients before and after treatment were measured.The extent of tumor necrosis was evaluated by enhanced CT and MRI month after the treatment.Results：The serum AFP significantly decreased after treatments in the two groups（P〈0.01）.The tumor necrosis ratio of the study group was 53.9%,significantly higher than that of the control group,which showed 32.8%（P〈0.01）.In the study group,the percentages of Treg cells significantly decreased from（8.43±2.58）% to（7.33±2.56）%（P〈0.01）.CD3^＋,CD4^＋ and the proportion of CD4^＋/CD8^＋ significantly increased from（49.07±6.59）%,（46.51±8.17）%,1.23±0.32 to（52.16±6.44）%,（50.63±8.27）%,1.52±0.46,while CD8^＋ cells decreased from（39.15±6.54）% to（34.79±6.18）%（P〈0.01）.In the control group,the percentages of Treg,CD3^＋,CD4^＋,CD8^＋ and the proportion of CD4^＋/CD8^＋ had no significant changes（P〉0.05）.Conclusion：TACE combined with cryoablation can increase tumor necrosis ratio,reduce the percentage of Treg cells and efficiently improve the immunological status in HCC patients.

关 键 词：癌 肝细胞 冷冻外科手术 T淋巴细胞 栓塞 药物疗法 

分 类 号：R735.7[医药卫生—肿瘤] R814.47[医药卫生—临床医学]