“套餐式”微创手术治疗对原发性肝癌患者免疫功能及MMP-9、VEGF的影响  

Effect of “package”minimally invasive surgery on immune function and MMP-9,VEGF in patients with primary liver cancer

作　　者：沈艳峰[1] 时志民[1] 李海滨[1] 苏英[1] 刘志军[1] 肖月升[1] 吴力洪[1] 王保梅[1] 朱艳芳[1] SHEN Yanfeng SHI Zhimin LI Haibin SU Ying LIU Zhijun XIAO Yuesheng WU Lihong WANG Baomei ZHU Yanfang(The Affiliated Hospital of Hebei University of Engineering, Handan 056001, Hebei, China)

机构地区：[1]河北工程大学附属医院,河北邯郸056001

出　　处：《现代中西医结合杂志》2016年第30期3324-3326,3414,共4页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：河北省科技厅重点项目(13277723D)

摘　　要：目的探讨"套餐式"微创手术治疗原发性肝癌的疗效及对血清T淋巴细胞亚群(CD3^+、CD4^+、CD8^+、CD4^+/CD8^+比值)、NK细胞(CD56^+)、金属蛋白酶-9(MMP-9)和血管内皮生长因子(VEGF)的影响。方法选取原发性肝癌患者85例,根据患者治疗意愿分为3组:A组35例行单纯肝动脉化疗栓塞(TACE)治疗,B组30例行TACE^+氩氦刀冷冻治疗,C组20例行TACE^+氩氦刀冷冻^+125I放射性粒子植入治疗;观察3组治疗前后血清T淋巴细胞亚群、CD56^+、MMP-9和VEGF水平变化情况,统计3组术后近期肿块缩小率及随访12,16个月复发率和生存率。结果治疗2周后,3组血清CD3^+、CD4^+、CD4^+/CD8^+比值、NK细胞水平均明显升高(P均<0.05),CD8^+和MMP-9、VEGF水平均明显降低(P均<0.05);治疗5周和7周后,B组和C组各指标改善情况均明显优于治疗2周后和A组(P均<0.05);术后7周,C组各指标改善情况均明显优于术后5周及B组(P均<0.05)。术后12周,B组和C组肿块缩小率明显高于A组(P<0.05),C组明显高于B组(P<0.05)。随访12,16个月,B组和C组复发率均明显低于A组,生存率均明显高于A组,且C组复发率明显低于B组,生存率明显高于B组,差异均有统计学意义(P均<0.05)。结论 "套餐式"微创治疗原发性肝癌效果更好,可明显改善机体免疫功能,抑制肿瘤血管的新生,降低复发率和病死率,值得临床推广应用。Objective It is to investigate the curative effect of＂package＂minimally invasive surgery in primary liver cancer,and observe its influence on the serum T lymphocyte subsets（ CD3~＋,CD4~＋,CD8~＋,CD4~＋/ CD8~＋ratio） and NK cells（ CD56~＋）,matrix metalloproteinase 9（ MMP- 9） and vascular endothelial growth factor（ VEGF）. Methods 85 patients with primary liver cancer were selected and divided into 3 groups according to the wishes of the patients： 35 cases in group A were treated with transcatheter arterial chemoembolization（ TACE）,30 cases in group B were treated with TACE ~＋ argon helium knife,20 cases in group C were treated with TACE ~＋ argon helium knife frozen ~＋125I radioactive seed implantation; the changes of serum T lymphocyte subsets,CD56~＋,MMP- 9 and VEGF levels were observed before and after treatment,and the postoperative tumor shrinkage rate and recurrence rate and survival rate follow-up 16,12 months were recorded in 3 groups.Results After 2 weeks of treatment,the serum levels of CD3~＋,CD4~＋,CD4~＋/ CD8~＋and NK were significantly increased,and the levels of CD8~＋,MMP- 9 and VEGF were significantly reduced in the 3 groups（ all P 〈0. 05）. After 5 weeks and 7weeks treatment,the indexes of group B and C were significantly better than those after 2 weeks and those of group A in the same time（ all P 〈0. 05）; at 7 weeks after operation,the improvement of the indexes of group C was significantly better than those at 5 weeks and those of group B in the same time（ all P 〈0. 05）; at 12 weeks after operation,the tumor shrinkage rate of group B and C were significantly higher than that of group A（ P 〈0. 05）,and group C was significantly higher than that of group B（ P 〈0. 05）. The recurrence rate in group B and C was significantly lower,and the survival rates were significantly higher than that in the group A at 16 months follow-up（ all P 〈0. 05）; and the recurrence rate of group C was significantly lower,survival rate was signifi

关 键 词：原发性肝癌 T淋巴细胞亚群 NK细胞 金属蛋白酶-9 血管内皮生长因子 

分 类 号：R735.7[医药卫生—肿瘤]