50例肝癌患者外周血淋巴细胞亚群比例与肝功能损伤的关系  

Correlations between subsets of peripheral lymphocytes and the liver dysfunction in 50 liver cancer patients

作　　者：张赫[1] 邹寒冰[2] 刘喆[3] 涂梦云 徐丹铧 夏强[1] 复 旦大学附属华山医院麻醉科

机构地区：[1]上海交通大学医学院附属仁济医院肝脏外科,200127 [2]上海交通大学医学院附属仁济医院中心实验室,200127 [3]上海交通大学医学院附属仁济医院南院风湿科,200127 [4]复旦大学附属华山医院麻醉科 [5]上海交通大学医学院附属仁济医院胃肠外科,200127

出　　处：《肝脏》2017年第11期994-997,共4页Chinese Hepatology

基　　金：上海市科委重要疾病多中心临床研究项目(15411950401)

摘　　要：目的探讨肝癌患者外周血CD3^+T淋巴细胞、CD4^+T淋巴细胞、CD8^+T淋巴细胞、NK细胞亚群与肝功能损伤的关系。方法回顾性分析上海交通大学医学院附属仁济医院50例肝癌住院患者(原发性肝癌10例,继发性肝癌30例,合并其他肝脏疾病10例)外周血淋巴细胞亚群比例。以10例合并其他肝脏疾病患者作为疾病对照组,40名健康体检者作为健康对照组,结合患者的肝功能指标进行差异性和相关性分析。结果原发性肝癌患者淋巴细胞亚群比例与合并其他肝病组及健康对照组比较差异均无统计学意义。继发性肝癌患者CD4^+T淋巴细胞比例显著低于健康对照组[(29.18±2.11)%比(35.68±0.56)%,P<0.05],NK细胞比例显著高于健康对照组[(21.45±1.69)%比(15.78±0.72)%,P<0.01],其淋巴细胞亚群比例与合并其他肝病组比较差异均无统计学意义。原发性肝癌患者肝细胞损伤者CD4^+T淋巴细胞比例显著高于未损伤者[(45.90±5.96)%比(30.93±1.76)%,P<0.05],CD4^+T淋巴细胞比例与ALT、AST均呈高度正相关(r=0.941、r=0.903,均P<0.01),肝脏代谢功能受损者CD8^+T细胞比例显著低于正常者[(27.00±4.63)%比(34.01±7.98)%,P<0.05],CD8^+T细胞比例与STB、PT均呈显著负相关(r=-0.596、r=-0.577,均P<0.05)。继发性肝癌患者肝细胞损伤者CD4^+T细胞比例显著低于未损伤者[(23.22±3.28)%比(33.24±2.29)%,P<0.05],CD8^+T细胞比例显著高于未损伤者[(34.70±4.26)%比(25.84±1.99)%,P<0.05],CD4^+/CD8^+比值与ALT、AST均呈显著负相关(r=-0.470、r=-0.424,均P<0.05),肝脏代谢功能受损者CD4^+T细胞比例显著高于正常者[(35.64±2.84)%比(25.56±2.57)%,P<0.05],CD4^+/CD8^+比值与STB、PT均呈显著正相关(r=0.400、r=0.481,均P<0.05)。结论肝癌患者外周血淋巴细胞亚群比例与肝功能损伤密切相关,机体免疫平衡状态的维持对于保护肝癌患者肝脏功能具有重要意义。Objective To investigate the correlations between subsets of peripheral lymphocytes and impaired liver function in liver cancer patients by assaying CD3^+T cells,CD4^+T cells,CD8^+T cells and NK cells in vivo.Methods Fifty liver cancer patients in Shanghai Renji Hospital were enrolled in the retrospective analysis,containing 10 patients with primary liver cancer,30 with secondary liver cancer and 10 with other liver diseases.CD3^+T cells,CD4^+T cells,CD8^+T cells and NK cells in these patients were assayed using flow cytometry.Ten patients with other liver diseases were recruited as disease control group,and 40 healthy blood donors were recruited as normal control group.Results Subsets of peripheral lymphocytes in primary liver cancer patients showed no differences with that in disease control group or normal control group.In secondary liver cancer patients,the proportion of CD4^+T cells in peripheral blood was much lower than that in normal control group(29.18±2.11% vs 35.68±0.56%,P<0.05),while the proportion of NK cells was much higher(21.45±1.69% vs 15.78±0.72%,P<0.01).However,there was no difference in lymphocyte subsets between secondary liver cancer patients and disease control group.Proportion of CD4^+T cells in primary liver cancer patients with hepatocellular injury was higher than that in patients without hepatocellular injury(45.90±5.96% vs 30.93±1.76%,P<0.05),which showed a positive correlation with alanine aminotransferase(ALT)(r=0.941,P<0.01)and aspartate aminotransferase(AST)(r=0.903,P<0.01).Proportion of CD8^+T cells in primary liver cancer patients with damage of liver metabolic function was lower than that in patients with no damage(27.00±4.63% vs 34.01±7.98%,P<0.05),which had negative correlations with serum total bilirubin(STB)(r=-0,596,P<0.05)and prothrombin time(PT)(r=-0.577,P<0.05).Secondary liver cancer patients with hepatocellular injury had a lower proportion of CD4^+T cells(23.22±3.28% vs 33.24±2.29%,P<0.05),while a higher proportion of CD8^+T cells(34.70±4.26% vs 25.84±1.99

关 键 词：肝癌 CD4^+T细胞 CD8^+T细胞 肝功能 

分 类 号：R735.7[医药卫生—肿瘤]