自体干细胞移植对晚期胃癌患者化疗后免疫重建作用的研究  

Study on immune reconstruction of patients with advanced gastric cancer treated by autologous peripheral blood stem cells following chemotherapy

作　　者：朱金水[1] 朱励[1] 王龙[1] 庄奇新[1] 陈维雄[1] 陈国强 马积庆[3] 

机构地区：[1]交通大学附属上海第六人民医院消化科,200233 [2]国家南方基因中心 [3]复旦大学肿瘤医院

出　　处：《中华消化杂志》2003年第11期674-677,共4页Chinese Journal of Digestion

摘　　要：目的　探讨自体外周造血干细胞移植对晚期胃癌化疗后患者免疫重建作用的影响。方法5 4例晚期胃癌患者进行数字化血管造影 (DSA)引导下的超选择高剂量动脉EAP方案 (VP16 10 0mg/m2+表阿霉素 6 0mg/m2 +卡铂 2 0 0mg/m2 )化疗后 ,其中 2 0例于 4 8h后接受自体外周血干细胞移植。结果　EAP动脉化疗后结合自体外周血干细胞移植方案对晚期胃癌患者的近期有效率为 85 .0 % ,显著高于单纯动脉化疗组的 2 9.3% (P <0 .0 1)。单纯动脉化疗组治疗前后患者的白细胞介素 2 (IL 2 )、γ 干扰素 (γ IFN)、可溶性白细胞介素 2受体 (sIL 2R)、白介素 2受体 (IL 2R)、自然杀伤细胞活性 (Nka)水平分别为 (2 0 .7± 2 .4 )U/ml,(6 4 5 .9± 4 8.2 )U/ml,(783.5± 77.1)U/ml,(13.2± 1.9) % ,(9.0± 1.1) %和(16 .3± 6 .4 )U/ml,(2 37.9± 17.4 )U/ml,(10 0 1.7± 112 .8)U/ml,(4.8± 0 .5 ) % ,(5 .93± 0 .2 ) %。γ IFN、IL 2R、NKa显著下降 (P <0 .0 1) ,sIL 2R则显著升高 (P <0 .0 1) ;而治疗组患者自体外周造血干细胞输注前及输注后 1周 ,IL 2、γ IFN、sIL 2R、IL 2R、Nka水平分别为 (2 1.7± 2 .3)U/ml,(6 32 .9± 4 7.8)U/ml,(76 8.3± 6 7.2 )U/ml,(12 .8± 1.7) % ,(9.8± 1.2 ) %和 (79.3± 7.4 )U/ml,(2Objective To evaluate the immune reconstruction of patients with advanced gastric cancer treated by autologous peripheral blood stem cells following chemotherapy. Methods 54 patients with advanced stage of gastric cancer were accepted arterial chemotherapy under the guidance of DSA with the regimen of high dosage of EAP (VP16 100 mg/m 2, topmycine60 mg/m 2 and carplatine200 mg/m 2). Among them 20 patients underwent autologous peripheral blood stem cell transplantation after 48 hours of the chemothrapy. Results Effective rate of EAP arterial chemotherapy combined with autologous peripheral blood stem cell transplantation was up to 85.0% (17/20) in advanced gastric cancer, 29.3% (10/34) in control group ( P <0.001 ). The levels of IL-2, IFNγ, sIL-2R, IL-2R and NKactivity before and after arterial chemotherapy were (20.7 +2.4) U/ml vs. (16.3 +6.4) U/ml , (645.9 +48.2) U/ml vs. (237.9 +17.4) U/ml , (783.5 + 77.1) U/ml vs. (1 001.7 + 112.8) U/ml , (13.2 + 1.9)% vs. (4.8 + 0.5)% and (9.0 + 1.1)% vs. (5.9+0.2)% respectively. The levels of IFNγ, IL-2R and Nk activity were decreased ( P <0.01 ), the level of sIL-2R was markedly increased ( P < 0.01 ). The levels of IL-2, IFNγ, sIL-2R, IL-2R and Nk activity were (21.7+2.3) U/ml vs. (79.3+7.4) U/ml, (632.9+47.8) U/ml vs. (2 356.5+121.3) U/ml, (768.3+ 67.2) U/ml vs. (234.8 +12.9) U/ml, (12.8+1.7) % vs. (28.8+3.1)% and (9.8+1.2)% vs. (29.3+3.2)% in treated group before and after arterial chemotherapy combined with autologous peripheral blood stem cell transplantation respectively. The levels of IL-2, IFNγ, IL-2R and Nk activity were markedly increased( P < 0.01 ). The level of sIL-2R was decreased after the therapy ( P < 0.01 ). The incidence of hepatic and renal function impairment, gastrointestinal side-effects and the decrease in white blood cells in treatment group and control group was 5%, 5%, 20% and 10% and 35.3%, 11.8%, 35.3% and 29.4% respectively. The difference between the two groups was significant ( P <0.01 ). Co

关 键 词：自体干细胞移植 晚期 胃癌 化疗 免疫重建作用 TNM分期 细胞因子 

分 类 号：R735.2[医药卫生—肿瘤]