Cyberknife立体定向放射治疗对恶性肿瘤患者外周血MDSCs和Tregs影响  

Effects of SBRT(Cyberknife)on MDSCs and Tregs in Peripheral Blood of Patients with Malignant Tumors

作　　者：陈远贵[1] 徐本华[1] 蓝艺明 张建平 黄妙云[1] 林庆良[1] CHEN Yuangui;XU Benhua;LAN Yiming;ZHANG Jianping;HUANG Miaoyun;LIN Qingliang(Department of Radiation Oncology,Fujian Medical University Union Hospital,Fuzhuo 350001,China;Department of Radiation Oncology,Jinjiang Traditional Chinese Medicine Hospital,Quanzhou 362200,China)

机构地区：[1]福建医科大学附属协和医院放疗科,福州350001 [2]晋江中医院放疗科,泉州362200

出　　处：《福建医科大学学报》2019年第4期246-251,共6页Journal of Fujian Medical University

基　　金：福建省中青年教师教育科研项目(JAT160204)

摘　　要：目的动态监测恶性肿瘤患者Cyberknife大剂量分割放射治疗后外周血髓系抑制细胞(MDSCs)和调节性T细胞(Tregs)的变化。方法收集25例(152个样本)Cyberknife立体定向放射治疗恶性肿瘤患者放疗前(Before RT)、放疗结束(After RT)、放疗后1周(After 1W)和放疗后1月(After 1M)外周血标本,并在CT/MR图像上测量Before RT组和After 1M组肿瘤最大直径。流式细胞术检测CD11b+CD33+HLADR-/low MDSCs在单核细胞中所占比率和CD4+CD25+CD127-/low Tregs占外周血CD4+细胞的百分比;分析MDSCs和Tregs在不同时间点的变化和两者之间的相关性;以实体瘤疗效评价标准评估疗效。结果MDSCs和Tregs所占比率(%):Before RT组(4.12±1.22)%和(8.57±3.72)%,After RT组(4.05±1.39)%和(8.27±3.68)%,After 1W组(3.82±0.79)%和(7.97±3.67)%,After 1M组(4.60±1.37)%和(11.16±3.67)%。外周血中的MDSCs和Tregs在Cyberknife大分割放疗后减少,1周后最低,1月后急剧增加,高于放疗前。组间配对样本t检验:After 1M组分别与Before RT组(MDSCs P=0.046,Tregs P=0.005)和After 1W组(MDSCs P=0.011,Tregs P=0.024)比较,差别有统计学意义。Before RT与After RT组之间变化MDSCs和Tregs呈正相关(P=0.032)。实体瘤疗效评价标准:稳定患者12例(48%),部分缓解患者10例(40%),完全缓解患者1例(4%),进展患者2例(8%)。Spearman相关性分析:Before RT组与After 1M组的肿瘤最大直径变化与After 1M组的MSDCs水平呈负相关(P=0.040)。结论Cyberknife可作为大剂量分割模型治疗恶性肿瘤;立体定向放射治疗影响恶性肿瘤患者外周血中MDSCs和Tregs的变化,动态监测MDSCs和Tregs可能在评价恶性肿瘤患者机体免疫抑制状态和最佳免疫干预时间点选择方面具有潜在的临床应用价值。Objective To dynamically monitor the level changes in MDSCs and Tregs in peripheral blood of patients with malignant tumors treated with Cyberknife.Methods 152 Peripheral blood specimens of 25 patients with malignant tumors were collected before and after radiotherapy,1 week,and 1 month after radiotherapy,The maximum diameter of target lesions before RT and 1 month after RT were measured on CT/MR imagines.The ratio of CD11b+CD33+HLADR-/low MDSCs in monocytes and the percentage of CD4+CD25+CD127-/low Tregs in peripheral blood CD4+cells were measured by flowcytometry.The treatment outcomes as well as changes in MDSCs and Tregs and correlations between them at different time points were analyzed.Results The percentage of MDSCs in monocytes(%)were(4.12±1.22)%,(4.05±1.39)%,(3.82±0.79)%,and(4.60±1.37)%,for before RT group,after RT group,after 1 week group,and after 1 month group,respectively.The corresponding percentage of Tregs in peripheral blood CD4+cells(%)were(8.57±3.72)%,(8.27±3.68)%,(7.97±3.67)%,and(11.16±3.67)%,respectively.The levels of MDSCs and Tregs in peripheral blood were both decreased after hypofractionated radiotherapy,reaching the lowest point after 1 week,and then increased sharply after 1 month,higher than that of before RT.The levels of MDSCs and Tregs after 1 month were significantly higher than that of before RT(MDSCs P=0.046,Tregs P=0.005)and after 1 week(MDSCs P=0.011,Tregs P=0.024).The level changes in MDSCs and Tregs between Before RT group and After RT group were both significantly positive correlated(P=0.032).For all patients,the rates of SD,PR,CR,and PD were 48%,40%,4%,and 8%,respectively.The changes in maximum diameter between before RT group and after RT group were negatively correlated with MDSCs level in the after 1 month group(P=0.040).Conclusion Malignant tumors can be treated by Cyberknife hypofraction model.The level changes in MDSCs and Tregs in peripheral blood of patients with malignant tumors can be affected by SBRT.Dynamic monitoring the level changes in MDSCs and Treg

关 键 词：放射性 放射外科手术 免疫疗法 免疫抑制法 T淋巴细胞 调节性 

分 类 号：R392.1[医药卫生—免疫学] R73[医药卫生—基础医学]