CIK维持治疗中晚期肺癌的临床观察及影响因素分析  

Clinical observation and influencing factors of CIKs in treatment of patients with advanced lung cancer

作　　者：罗虎[1] 宫亮[1] 陈永峰[1] 祝冰晶[1] 周向东[1] 杨智[2] 余时沧[2] 王丹妮[3] 

机构地区：[1]第三军医大学西南医院呼吸内科,重庆400038 [2]第三军医大学西南医院生物治疗中心,重庆400038 [3]第三军医大学西南医院检验科,重庆400038

出　　处：《第三军医大学学报》2013年第6期569-572,共4页Journal of Third Military Medical University

摘　　要：目的分析细胞因子诱导的杀伤细胞(cytokine-induced killer cells,CIK)作为维持治疗手段治疗晚期肺癌患者前后免疫系统变化情况,评估CIK细胞治疗晚期肺癌的有效性并分析其影响因素,对其安全性做初步评估。方法选取42例中晚期肺癌患者,并根据性别、年龄、病理类型选择同期行最佳支持治疗的38例患者作为对照组。统计分析应用CIK细胞治疗前后免疫学指标(T细胞亚群、免疫球蛋白等)变化特点,评估其治疗的近期疗效(有效率、控制率),并分析影响CIK治疗效果的因素,比较患者在治疗前后的生活质量变化(KPS评分),观察细胞治疗的安全性。结果相比非肺癌患者而言,肺癌患者CD3+、CD4+及CD8+T细胞比例均显著降低(P<0.05);CIK细胞治疗后,CD3+、CD4+T细胞及CD4+/CD8+比例较治疗前显著提高(P<0.05),而血液中的免疫球蛋白(IgA、IgG、IgM)及肿瘤标志物CEA均无明显改变(P>0.05)。CIK治疗组有效率及疾病控制率分别为42.9%和83.3%,均显著高于对照组的7.9%及55.3%(P<0.05);肿瘤分期、是否合并重要脏器转移及KPS评分都是影响CIK治疗效果的因素(P<0.05),而性别、年龄、病理类型则对CIK治疗效果无明显影响(P>0.05);CIK治疗前后KPS评分改善差异有统计学意义(P=0.001),而对照组KPS评分无明显改善(P=0.191);CIK治疗组中4例患者出现一过性的发热或寒战外,未见明显毒副作用。结论 CIK细胞作为维持治疗手段,可改善肺癌患者免疫失衡,提高有效率和疾病控制率,并在一定程度上改善患者的生活质量且无明显毒副作用。Objective To analyze the changes of immune system after cytokine-induced killer cells （CIKs） as maintenance therapy in treatment of patients with advanced lung cancer, to assess the effectiveness and safety of CIKs treatment, and to find out the factors that may influence the efficacy. Methods Forty-two patients with advanced lung cancer （stage m to 1v ） admitted to the First Affiliated Hospital of Third Military Medical University in Chongqing from July 2011 to July 2012 and treated with CIKs were enrolled as a CIKs group, and another 38 advanced lung cancer patients treated with optimal supportive care during the same period were enrolled as a control group. The changes of immune system （ including subsets of T cells, immuno- globulin A, immunoglobulin G and immunoglobulin M）, therapeutic effects （response rate and disease control rate） , quality of life （KPS score）, and side effects were compared between the two groups. Furthermore, the factors that might influence the efficacy of CIKs therapy were evaluated. Results Compared with people without lung cancer, the ratios of CD3 ~ , CD4 ~ and CD8 ~ T cells significantly decreased （ P 〈 0.05 ） in lung cancer patients. After CIKs treatment, the ratios of CD3 ~ and CD4~ T cells and CIM~/CD8 ~ significantly increased （P 〈 0.05 ）, while there was no significant change in CD8 ~ T cells, immunoglobulin A, immuno- globulin G, immunoglobulin M and cancer embryo antigen （CEA） （ P 〉 0.05 ）. The response rate （RR） and disease control rate （DCR） were 42.9% and 83.3% in the CIKs group, which were significantly higher than those in the control group （7.9% and 55.3% ）. Tumor staging, metastasis in vital organs and KPS score were influencing factors for the effectiveness of CIKs treatment （P 〈 0.05 ）, while sex, age and pathological type had no significant effect （P 〉0.05 ）. KPS score significantly increased in the CIKs group （P = 0. 001 ）, while no obvious change was observed in the control group （P = 0. 191

关 键 词：CIK 肺癌 免疫系统 疗效 影响因素 安全性 

分 类 号：R734.2[医药卫生—肿瘤] R730.51[医药卫生—临床医学]