中晚期非小细胞肺癌患者化疗前后T淋巴细胞亚群表达差异分析及临床意义  

Differential expression of T lymphocyte subsets in patients with advanced non-small cell lung cancer before and after chemotherapy and its clinical significance

作　　者：陈艳丽 王媛媛 张勇[1] 李文洁 Chen Yanli;Wang Yuanyuan;Zhang Yong;Li Wenjie(Department of Respiratory Medicine,Tangdu Hospital,Air Force Medical University,Xi′an 710038,China)

机构地区：[1]空军( 第四) 军医大学第二附属医院呼吸内科

出　　处：《中华肺部疾病杂志（电子版）》2020年第1期13-17,共5页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：国家自然科学基金资助项目(81071933)

摘　　要：目的回顾性分析中晚期非小细胞肺癌患者化疗前后淋巴细胞亚群表达差异,以及与化疗疗效的相关性。方法选择2014年1月至2018年6月在我院进行化疗治疗的中晚期非小细胞肺癌患者122例作为病例组,同期在我院进行健康体检64例作为对照组,对比分析各组T淋巴细胞亚群CD3^+(%)、CD8^+(%)、CD4^+(%)、CD4^+/CD8^+细胞比值差异。结果病例组化疗前及后的CD3^+(%)、CD4^+(%)、CD4^+/CD8^+细胞比值均显著低于对照组(P<0.05);化疗后CD3^+(%)、CD4^+(%)、CD4^+/CD8^+细胞比值均较化疗前有显著升高(P<0.05);化疗前后病例组患者CD8^+(%)略高于对照组,但差异未发现统计学意义(P>0.05),且化疗前后CD8^+(%)对比,差异未发现统计学意义(P>0.05)。化疗治疗后,将病例组分为疾病控制组共90例(73.77%),其中完全缓解(CR)0例,部分缓解(PR)25例(20.49%),疾病稳定(SD)65例(53.28%);疾病进展(PD)32例(26.23%)。疾病控制组的年龄、性别与疾病进展组对比,差异无统计学意义(P>0.05)。疾病控制组治疗前CD3^+(%)、CD4^+(%)、CD8^+(%)、CD4^+/CD8^+与疾病进展组对比,差异均无统计学差异(P>0.05),疾病控制组治疗后CD3^+(%)、CD4^+(%)、CD4^+/CD8^+显著高于疾病进展组,差异均具有统计学意义(P<0.05)。DCR和PD两组治疗后CD3^+(%)、CD4^+(%)、CD4^+/CD8^+细胞比值均显著高于治疗前。两组治疗后CD8^+(%)对比,差异无统计学意义(P>0.05)。治疗后CD3^+(%)、CD4^+(%)、CD4^+/CD8^+水平在预测非小细胞肺癌患者化疗效果的AUC面积分别为:0.789、0.823、0.758。通过最大约登指数计算得出CD3^+(%)、CD4^+(%)、CD4^+/CD8^+指标的最大AUC面积相应参数截止值,其中CD3^+(%)截止值为65.95(%)(敏感度=83.30%,特异性=78.60%,P=0.021),CD4^+(%)截止值为39.81(%)(敏感度=87.30%,特异性=85.20%,P=0.034),CD4^+/CD8^+截止值为1.250(敏感度=81.20%,特异性=76.70%,P=0.017)。结论中晚期非小细胞肺癌患者的T淋巴细胞比例显著降低,细胞免疫功能呈Objective To analyze the expression of lymphocyte subsets in the patients with advanced non-small cell lung cancer(NSCLC)before and after chemotherapy.Methods A total of 122 patients with advanced NSCLC who received chemotherapy in our hospital from January 2014 to June 2018 were selected as the study subjects(case group)and 64 healthy volunteers were taken as the control group during the same period.The differences of T lymphocyte subsets CD3^+(%),CD8^+(%),CD4^+(%)and CD4^+/CD8^+ cell ratio in each group were compared and analyzed.Results The cell ratios of CD3^+(%),CD4^+(%)and CD4^+/CD8^+ in the case group before and after chemotherapy were significantly lower than those of the control group(P<0.05).The cell ratios of CD3^+(%),CD4^+(%)and CD4^+/CD8^+ cells in the case group after chemotherapy were significantly higher than those before chemotherapy(P<0.05).The cell ratios of CD8^+(%)in the case group before and after chemotherapy were slightly higher than those of the control group,but no significant difference was found(P>0.05).And there was no significant difference in CD8^+(%)between the two groups(P>0.05).After chemotherapy,the case group was divided into a disease control group(n=90,73.77%),which included complete remission(CR)in 0 case,partial remission(PR)in 25 cases(20.49%)and disease stability(SD)in 65 cases(53.28%),and a disease progression group(n=32,26.23%).There was no significant difference in age and sex between the disease control group and the disease progression group(P>0.05).CD3^+(%),CD4^+(%),CD8^+(%)and CD4^+/CD8^+ in the disease control group had no significant difference compared with the disease progression group before treatment(P>0.05).CD3^+(%),CD4^+(%)and CD4^+/CD8^+ in the disease control group were significantly higher than those in the disease progression group after treatment(P<0.05).The cell ratios of CD3^+(%),CD4^+(%)and CD4^+/CD8^+in both groups after treatment were significantly higher than those before treatment.There was no significant difference in CD8^+(%)between the two gr

关 键 词：中晚期非小细胞肺癌 化疗 T淋巴细胞亚群 

分 类 号：R563[医药卫生—呼吸系统]