伴HIV感染的结直肠癌患者化疗后自体骨髓回输临床观察  

Clinical observation of autologous bone marrow transfusion after chemotherapy in HIV infected patients with colorectal cancer

作　　者：刘保池[1] 冯铁男[2] 李垒[1] 司炎辉[1] 张伟伟[1] 刘新[1] 刘启领 王盟[3] 徐念沁 

机构地区：[1]上海市公共卫生临床中心外科,201508 [2]上海交通大学公共卫生学院,200025 [3]郑州大学第一附属医院消化科,450052 [4]南京三生生物技术有限公司,210032

出　　处：《中华结直肠疾病电子杂志》2017年第3期212-216,共5页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：上海市科委课题(No.15411963100)

摘　　要：目的探讨HIV感染者合并结直肠癌化疗前采集保存和化疗后回输自体骨髓对促进骨髓重建和免疫重建的效果。方法对13例结肠癌和8例直肠癌合并HIV感染患者做手术切除后化疗,其中12例接受化疗治疗,9例患者在手术时经肠系膜静脉插管埋置输液港,自体骨髓-80℃冷冻保存,化疗后经输液港输入保存的自体骨髓,之后对相关临床指标进行比较。结果化疗前2组淋巴细胞亚群,血细胞分析差异无统计学意义。术后,自体骨髓保存回输组的CD4^+T淋巴细胞在手术24个月后显著高于常规化疗组(t=4.58,P<0.001),CD8^+T淋巴细胞均值高于常规化疗组,但总体差异无统计学意义,白细胞计数比常规化疗组明显增高,其中在第1、3、6次化疗后差异有显著统计学意义(t=4.08,P<0.001;t=7.18,P<0.001;t=7.74,P<0.001),血小板均值高于常规化疗组,但总体差异无统计学意义,血红蛋白均值高于常规化疗组,其中第1、6次化疗后差异有显著统计学意义(t=2.43,P=0.03;t=2.51,P=0.02)。化疗加输注骨髓组手术后2年内2例死于肿瘤转移(2/9),化疗不输注骨髓组手术后2年内4例死于肿瘤转移(4/12),差异无统计学意义(P=0.66)。结论化疗前采集自体骨髓保存,化疗后回输保存的骨髓可以促进白细胞计数较快恢复,对骨髓重建和免疫重建的作用有待进一步研究。Objective To discuss the therapeutic effect of a treatment that collected and preserved autologous bone marrow before chemotherapy and transfused it into HIV infected patients upon how to reconstruct the marrow and immune system. Methods Thirteen HIV patients with colon cancer and 8 HIV infected patients with colorectal cancer were underwent surgery. After surgery, Twelve patients received regular chemotherapy. Nine patients＇ marrow were collected when they were under surgery using infusion port that were planted through mesenteric venous. The marrow were persevered under -80-C. After chemotherapy, the marrow of each patients were transfused into her/his body through the planted infusion port. Then relative indicators were compared between the two groups. Results Before chemotherapy, the peripheral blood pictures difference of the two groups of patients＇ lymphocyte subpopulation is not significance. After surgery, the group of marrow preservation and transfusion have significant higher CD4 ＋ T counts than the control group at the 24 month （t=4.58, P - 0.001）. The average CD8 ＋ T counts of marrow preservation and transfusion group were higher than the control group, but no significance. The WBC counts were higher than control group. The significant difference occurred at first, third and the sixth chemotherapy （t=4.08, P 〈 0.001, t=7.18, P〈 0.001, t=7.74, P〈 0.01）. The average blood platelets level was higher than the control group, but no significance. The average hemoglobin level was higher. The significant difference occurred at first and sixth chemotherapy （t=2.43, P=0.03, t=2.51, P=0.02）. Two patients in marrow preservation and transfusion group died from metastasis in two years （2/9）. Four patients in control group died died from metastasis in two years （4/12）. The difference was not significant （P=0.66）. Conclusion It can improve the growth of WBC to collecting marrow before chemotherapy and transfusion after chemotherapy. The therapeutic effect of reconstructing the ma

关 键 词：结直肠肿瘤 化学治疗 HIV感染 骨髓移植 免疫重建 

分 类 号：R512.91[医药卫生—内科学]