氩氦刀冷冻治疗对肺癌患者免疫功能影响及临床意义  

Change and significance of immune function before and after CT guided argon-helium cryoablation treatment on lung cancer patients

作　　者：李龙飞[1] 柳晨[2] 曹生亚[1] 徐继磊 王元锦 索风 魏祥举 主媛媛 渠敬明[1] LI Long-fei;LIU Chen;CAO Sheng-ya;XU Ji-lei;WANG Yuan-jin;SUO Feng;WEI Xiang-ju;ZHU Yuan-yuan;QU Jing-ming(Department of Thoracic Surgery,Xuzhou Cancer Hospital,Xuzhou 221005,China;Department of Interventional Therapy,Beijing Cancer Hospital,Beijing 100142,China)

机构地区：[1]徐州市肿瘤医院胸外科,江苏徐州221005 [2]北京大学肿瘤医院介入治疗科,北京100142

出　　处：《中华肿瘤防治杂志》2021年第16期1231-1235,共5页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的通过观察CT引导下经皮穿刺氩氦刀靶向冷冻治疗肺癌后外周血T细胞亚群变化,评价氩氦冷冻治疗肺癌对机体免疫功能的影响。方法选取2017-01-02-2019-02-28徐州市肿瘤医院收治的42例肺癌患者纳入病例组,患者均采用CT引导下的氩氦刀冷冻治疗;按照性别和年龄1:1匹配原则选取同期健康体检的42名健康体检者纳入对照组。采用流式细胞仪检测观察组治疗前1d,术后2周和术后30d以及对照组CD3^(+)、CD4^(+)、CD8^(+)百分比,并计算CD4^(+)/CD8^(+)比值。评价治疗后8周疗效及患者生活质量。结果Ⅰ/Ⅱ期肺癌患者CD3^(+)(t=4.059,P<0.001)、CD4^(+)(t=2.041,P=0.048)、CD4^(+)/CD8^(+)(t=2.457,P=0.018)水平高于Ⅲ/Ⅳ期患者,差异有统计学意义。病例组治疗前1d、术后2周和术后30d的CD3^(+)水平分别为(47.83±7.85)%、(54.07±6.88)%和(62.47±3.90)%,F=50.120,P<0.001;CD4^(+)水平分别为(26.95±2.88)%、(31.30±5.20)%和(36.45±3.35)%,F=58.750,P=<0.001;CD4^(+)/CD8^(+)水平分别为0.96±0.16、1.36±0.28和1.73±0.35,F=87.140,P<0.001;CD8^(+)水平分别为(28.72±4.18)%、(23.24±2.58)%和(21.76±4.14)%,F=44.510,P=<0.001。病例组不同时间点外周血CD3^(+)、CD4^(+)和CD4^(+)/CD8^(+)均低于对照组,P<0.001;CD8^(+)水平均高于对照组,P<0.001。患者肺癌治疗总有效率为66.67%,获益率为90.45%,其中完全缓解(CR)、部分缓解(PR)、疾病稳定、疾病进展和CR^(+)PR分别为4例(9.52%)、24例(57.14%)、10例(23.82%)、4例(9.52%)和28例(66.67%)。术后90.48%(38/42)患者有局部轻微疼痛,仅7.14%(3/42)患者应用强痛定止痛治疗,14.28%(6/42)患者发热,体温38℃左右。病例组患者术后KPS评分为(76.35±7.00)分,高于治疗前的(70.16±11.70)分,差异有统计学意义,t=-2.696,P=0.010。结论肺癌患者经氩氦刀冷冻治疗后,其机体免疫功能得到增强,生活质量提高。Objective To observe and explore the change and influence of treating lung cancer with CT guided argon-helium cryoablation on T-lymphocyte activity.Methods From January 2,2017to February 28,2019,the 42lung cancer patients were selected as case group and adopted CT guided argon-helium cryoablation treatment,and 42health volunteers were chosen as the control group(1:1matched case group as age and gender).We monitored the proportional changing of peripheral blood CD3^(+),CD4^(+),CD8^(+)T-lymphocyte subset and the proportional changing of CD4^(+)/CD8^(+)T-lymphocyte by following cytometer respectively,1day before,2weeks and 30days after the argon-helium cryoablation.All the patients were evaluated the short-term efficacy of ablation therapy and life quality after 8weeks.Results The level of CD3^(+)(t=4.059,P<0.001),CD4^(+)(t=2.041,P=0.048)and CD4^(+)/CD8^(+)(t=2.457,P=0.018)inⅠ/Ⅱlung cancer patients was higher than those in stageⅢ/Ⅳlung cancer patients.The CD3^(+)levels of 1dbefore treatment,2weeks after surgery and30dafter surgery in the case group were (47.83±7.85)%,(54.07±6.88)%and (62.47±3.90)%,(F=50.120,P<0.001).The CD4^(+)levels were(26.95±2.88)%,(31.30±5.20)%and (36.45±3.35)%,F=58.75,P<0.001.CD4^(+)/CD8^(+)levels were 0.96±0.16,1.36±0.28and 1.73±0.35(F=87.14,P<0.001).The CD8^(+)levels were(28.72±4.18)%,(23.24±2.58)%and (21.76±4.14)%,F=44.51,P<0.001.Peripheral blood immune function CD3^(+)level,CD4^(+)and CD4^(+)/CD8^(+)in the case group were lower than those in the control group at different time points(P<0.001),while CD8^(+)levels were higher than those of the control group(P<0.001).The total effective rate of lung cancer treatment for patients was 66.67%,with a benefit rate of 90.45%,including 4(9.52%)CR,24(57.14%)PR,10(23.82%)SD,4(9.52%)PD and 28(66.67%)CR^(+)PR.Postoperatively,90.48%(38/42)of the patients had mild local pain,only 7.14%(3/42)of the patients applied prednisone for pain management,and 14.28%(6/42)of the patients had fever with a temperature of about 38℃.The postoperative

关 键 词：氩氦刀冷冻治疗 肺癌 T淋巴细胞亚群 免疫功能 

分 类 号：R734.2[医药卫生—肿瘤]