冷循环射频消融治疗后肝癌患者调节性T细胞变化及其对预后的影响  

Changes of regulatory T cells in patients with hepatocellular carcinoma after percutaneous cool- tip radiofrequency ablation and its influence on the prognosis

作　　者：曾江正[1] 刘光清[2] 郝新宝[1] 洪涛[1] 张建辉[2] 苏群豪[1] 黄美珠[1] 黄芬[1] 雷俊华[1] 

机构地区：[1]海口海南医学院附属医院肿瘤研究所肿瘤内科,570102 [2]海口海南医学院附属医院超声科,570102

出　　处：《介入放射学杂志》2014年第6期491-495,共5页Journal of Interventional Radiology

基　　金：海南省自然科学基金(811211)

摘　　要：目的探讨冷循环射频消融(RFA)治疗对肝癌(HCC)患者调节性T细胞(Treg)变化及其对预后的影响。方法流式细胞仪检测冷循环RFA治疗前,治疗后1、4、7和12个月后外周血Treg的变化。随访期间采用超声造影或肝脏增强CT评估疗效。采用受试者工作特征(ROC)曲线及Kaplan-Meier生存函数的方法分析Treg动态变化与肿瘤无进展生存期的关系。结果 RFA术后1个月,30例患者肿瘤缓解(TR)率93.3%(28/30),肿瘤进展(TP)率6.67%(2/30)。RFA术前Treg(9.42±1.16)%,术后1个月(6.55±0.97)%,较术前显著下降(t=15.325,P<0.01)。经12个月随访,TR率33.3%(10/30),TP率66.7%(20/30)。TR组术前Treg为(8.75±0.72)%,显著低于TP组(9.76±1.20)%(t=-2.448,P=0.021)。ROC曲线表明Treg谷值以4.82%为最佳临界值时,灵敏度为90.0%,特异度为60.0%;Treg达谷时间以5.5个月为最佳临界值,灵敏度为70.0%,特异度为85.0%。采用Kaplan-Meier曲线分析表明,肝癌RFA术后Treg谷值≤4.82%的肿瘤无进展生存率优于Treg谷值>4.82%的患者;Treg达谷时间≥5.5个月的患者预后优于Treg达谷时间<5.5个月的患者,Log-rank检验分别为χ2=5.207,P=0.023;χ2=22.079,P<0.01。结论冷循环RFA可以下调Treg水平,并且Treg谷值及Treg达谷时间在一定程度上反映RFA治疗HCC患者的预后。Objective To investigate the changes of regulatory T cells （Treg） in patients with hepatocellular carcinoma （HCC） after ultrasound- guided percutaneous cool- tip radiofrequency ablation （RFA）, and to discuss its influence on the prognosis. Methods A total of 30 patients with HCC were enrolled in this study. The percentage of Treg in peripheral blood was estimated with flow cytometry before RFA and one, 4, 7 and 12 months after RFA. During the follow-up period, the therapeutic effects were evaluated by contrast enhanced sonography or contrast enhanced CT scanning. By using the methods of receiver operating characteristic （ROC） curve and Kaplan-Meier survival function, the correlation of Treg dynamic changes with the progression-free survival time was analyzed. Results One month after RTA, the tumor response （TR） rate in the 30 patients was 93.3% （28/30）, the tumor progression （TP） rate was 6.67%（2/30）. The percentage of Treg before RFA was （9.42 ± 1.16）%, which decreased to （6.55 ± 0.97）% one month after RFA, the difference was statistically significant （t = 15.325, P 4.82%. PFS of patients with reaching Treg nadir≥5.5 months was significantly higher than that of patients with reaching Treg nadir〈5.5 months. Log-rank test results were字2=5.207, P=0.023; 字2=22.079, P 〈 0.001, respectively. Conclusion Percutaneous cool-tip radiofrequency ablation can decrease the percentage of Treg cells. Besides, Treg nadir and the time reaching Treg nadir can reflect the prognosis of HCC patients after RFA to a certain extent.

关 键 词：冷循环电极 射频消融 肝癌 调节性T细胞 受试者工作特征曲线 

分 类 号：R735.7[医药卫生—肿瘤]