晚期非小细胞肺癌患者化疗对免疫功能的影响  

Influence of chemotherapy on immune function of patients with advanced non-small cell lung cancer

作　　者：徐校成[1] 吕颖颖[1] 徐佳灵[1] 

机构地区：[1]杭州市萧山区第一人民医院肿瘤内科,浙江杭州311200

出　　处：《中华医院感染学杂志》2015年第6期1312-1314,共3页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生基金资助项目(2013KYB104)

摘　　要：目的：探讨化疗对晚期非小细胞肺癌（NSCLC）患者免疫功能的影响，分析化疗导致的不良反应与免疫功能和肺部感染的相关性，提高晚期 NSCLC 化疗患者的生命质量和治疗的耐受性。方法回顾性分析2009年1月－2012年6月127例Ⅲ～Ⅳ期的 NSCLC 行化疗治疗患者临床资料，评价其治疗后的不良反应，采用流式细胞仪检测 CD3＋、CD4＋、CD8＋和 CD4＋／CD8＋比值，统计肺部感染发生率，并分析肺部感染的相关危险因素。结果33例发生肺部感染，发生率为25．98％；化疗后不良反应主要以消化道症状为主，发生率为44．80％，其中Ⅰ～Ⅱ度占18．90％，Ⅲ～Ⅳ度占25．98％；白细胞减少发生率为37．79％，其中Ⅰ～Ⅱ 度占14．96％、Ⅲ～Ⅳ度占22．83％；治疗后 CD3＋、CD4＋、CD8＋和 CD4＋／CD8＋比值均明显下降，与治疗前比较差异均有统计学意义（P ＜0．05）；logistic 回归分析显示，年龄、白细胞减少、化疗疗程、肿瘤分期和 CD4＋／CD8＋降低是肺部感染的独立危险因素（P＜ 0．05）。结论晚期 NSCLC 患者化疗后的骨髓抑制和免疫功能下降是造成肺部感染的主要原因。OBJECTIVE To explore the influence of chemotherapy on immune function of the patients with advanced non-small cell lung cancer （NSCLC） and analyze the relationship between the chemotherapy-induced side effects and the immune function and pulmonary infections so as to improve the life quality of the patients as well as the tolerance of chemotherapy .METHODS A total of 127 NSCLC （ Ⅲ - Ⅳ stage） patients who underwent the chemo-therapy from Jan 2009 to Jun 2012 were enrolled in the study ,then the clinical data of the participants were retro-spectively analyzed ,the toxic and side effects were evaluated after the treatment ,the levels of CD3 ＋ ,CD4 ＋ ,and CD8 ＋ ,as well as the ratio of CD4 ＋ /CD8 ＋ were determined by using flow cytometry ,the incidence of pulmonary infections was statistically analyzed ,and the related risk factors for the pulmonary infections were analyzed . RESULTS The pulmonary infections occurred in 33 cases ,with the incidence rate of 25 .98% .The gastrointestinal symptoms were dominant among the side effects after the chemotherapy with the incidence rate of 44 .80% ,of which 18 .90% were grade Ⅰ - Ⅱ , 25 .98% were grade Ⅲ - Ⅳ . The patients with leucopenia accounted for 37 .79% ,of which 14 .96% were grade Ⅰ - Ⅱ ,22 .83% were grade Ⅲ - Ⅳ .After the treatment ,the levels of CD3 ＋ ,CD4 ＋ ,and CD8 ＋ as well as the ratio of CD4 ＋ /CD8 ＋ were significantly reduced ,as compared with those before the treatment ,there was significant difference （P〈 0 .05） .The logistic regression analysis indicated that the age ,leucopenia ,course of chemotherapy ,stage of tumor ,and decrease of CD4 ＋ /CD8 ＋ were the independent risk factors for the pulmonary infections .CONCLUSION The bone morrow suppression and decline in immune function are the leading causes of the pulmonary infections in the patients with advanced NSCLC after the chemo -therapy .

关 键 词：非小细胞肺癌 免疫功能 肺部感染 骨髓抑制 细胞免疫 

分 类 号：R734.2[医药卫生—肿瘤]