中晚期非小细胞肺癌患者培美曲塞联合铂类化疗前后免疫抑制细胞检测及意义  

Detection and significance of immunosuppressive cells before and after pemetrexed combined platinum chemotherapy in patients with advanced non-small cell lung cancer

作　　者：金珊珊[1] 束永前[1] JIN Shan-shan;SHU Yong-qian(Department of Oncology ,First Affiliated Hospital with Nanjing Medical University,Nanjing 210029 ,P.R.China)

机构地区：[1]南京医科大学第一附属医院肿瘤科,江苏南京210029

出　　处：《中华肿瘤防治杂志》2018年第22期1583-1587,共5页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的研究表明,在恶性肿瘤患者体内,普遍存在着免疫抑制和免疫逃逸的一种微环境,使患者免疫系统的功能存在不同程度的抑制。本研究将检测中晚期非小细胞肺癌患者应用培美曲塞联合铂类化疗前后外周血中髓源抑制细胞(myeloid-derived suppressor cells,MDSC)和调节性T细胞(Tregs)的比例,分析其对肺癌患者免疫功能的影响及临床意义。方法选择2016-05-01-2018-02-01南京医科大学第一附属医院肿瘤生物治疗中心就诊的中晚期非小细胞肺癌患者43例及2017年江苏省人民医院进行体检的健康人40名,肺癌患者均接受培美曲塞单药或联合铂类化疗,每例患者至少治疗4个周期后评价疗效。采用流式细胞仪检测肺癌患者化疗前后及健康体检者外周血中MDSC和Treg细胞的比例。结果根据化疗后的疗效评价,43例患者分为疾病进展组和疾病控制组,CR、PR、SD统称为疾病控制组。与健康对照组相比,肺癌患者化疗前外周血中MDSC为(4.89±1.86)%,明显高于对照组的(0.75±0.24)%;Treg细胞化疗前为(11.54±2.44)%,高于对照组的(5.76±0.77)%,P<0.001;在治疗4个周期后,患者外周血中MDSC(2.3±1.64)%和Treg细胞(6.4±0.98)%的比例下降,差异有统计学意义,P值分别为0.004和0.003;疾病控制组患者MDSC(1.39±0.99)%和Treg细胞(5.83±0.55)%比例均较化疗前降低;疾病进展组患者MDSC(3.68±1.45)%和Treg细胞(7.43±0.63)%的比例均低于化疗前。无论是化疗前,还是化疗后,中晚期非小细胞肺癌患者外周血中MDSC与Treg细胞之间均存在正相关关系,均P<0.001。结论中晚期非小细胞肺癌患者的免疫功能低下与外周血中MDSC和Treg细胞的比例相关,培美曲塞单药或联合铂类治疗能够抑制MDSC和Treg细胞的比例,增强机体抗肿瘤免疫。检测外周血中MDSC和Treg细胞比例可评估患者的免疫功能状态,对患者临床疗效具有指导意义。OBJECTIVE Studies have shown that there is a general microenvironment of immune suppression and immune escape in patients with malignant tumors,and the function of the immune system is inhibited to varying degrees.The aim of this study was to investigate the proportion of Myeloid-Derived Suppressor Cells(MDSC)and regulatory T cells(Tregs)in peripheral blood of patients with advanced non-small cell lung cancer before and after pemetrexed combined platinum chemotherapy,and to analyze the effect on the immune function of lung cancer patients and its clinical significance.METHODS Forty-three patients with advanced non-small cell lung cancer(NSCLC)who were admitted to the Cancer Biotherapy Center of the First Affiliated Hospital with Nanjing Medical University from May 2016 to February2018and 40 healthy people who underwent physical examination in Jiangsu Provincial People’s Hospital in 2017 were selected.They were treated with pemetrexed single or combined platinum chemotherapy.Each patient was treated for at least4 cycles and evaluated for efficacy.The ratio of MDSC and Treg cells in peripheral blood of 43 lung cancer patients before and after chemotherapy and healthy persons were detected by flow cytometry.RESULTS According to the evaluation of curative effect after chemotherapy,43 patients were divided into disease progression group and disease control group.CR,PR and SD were collectively called disease control group.Compared with the healthy control group[MDSC(0.75±0.24)%,Tregs(5.76±0.77)%],the proportion of MDSC[before(4.89±1.86)%,after(2.3±1.64)%]and Treg cells[before(11.54±2.44)%,after(6.4±0.98)%]in peripheral blood of patients with lung cancer were increased significantly before chemotherapy(P<0.001);after 4cycles of treatment,the proportion of MDSC(2.3±1.64)% and Treg cells(6.4±0.98)% in peripheral blood was decreased significantly(P=0.004,P=0.003);the proportion of MDSC(1.39±0.99)% and Treg cells(5.83±0.55)%in disease control group was lower than that before chemotherapy(P=0.025,P=0.006);the pro

关 键 词：非小细胞肺癌 培美曲塞 MDSC Treg肿瘤免疫抑制 

分 类 号：R734.2[医药卫生—肿瘤]