AFP-L3阳性肝细胞癌患者肿瘤分期和外周血淋巴细胞亚群的研究

Tumor stages and peripheral blood lymphocyte subsets in patients with AFP-L3-positive hepatocellular carcinoma

目的:分析小扁豆凝素结合型甲胎蛋白(AFP-L3)阳性的肝细胞癌患者肿瘤分期及外周血淋巴细胞的改变,探讨AFP-L3水平与肿瘤分期及免疫状态的关系。方法:采集60例肝细胞癌患者外周血,检测AFP及AFP-L3含量。根据外周血AFP-L3比例将60例原发性肝细胞癌患者分为2组:AFP-L3(+)组和AFP-L3(-)组。流式细胞术检测外周血中各淋巴细胞亚群(NK、CD4+、CD8+、CD4/CD8、Treg)的比例。结果:AFP-L3(+)组患者UICC分期Ⅲ+Ⅳ期为29例,AFP-L3(-)组为7例;AFP-L3(+)组患者BCLC分期C+D期为20例,AFP-L3(-)组为3例。AFP-L3(+)组患者发生血管侵犯为17例,远高于AFP-L3(-)组(1例)。AFP-L3(+)组患者外周血中NK细胞比例及CD4/CD8比值下降,CD8+T和Treg细胞显著比例上升。结论:外周血AFP-L3阳性的肝癌患者容易发生血管侵犯,且分期较差,可能与淋巴细胞亚群发生变化、免疫系统受到抑制有关。

AIM： To analyze the variations of tumor stages and peripheral blood lymphocyte subsets in Lens culinaris agglutinin-reactive alpha-fetoprotein（AFP-L3）-positive hepatocellular carcinoma（HCC） and to explore the relationship between tumor stage,immune state and AFP-L3.METHODS： Peripheral blood of sixty HCC patients was collected.The concentrations of AFP and AFP-L3 were detected.The patients were divided into 2 groups according to the expression of AFP-L3： AFP-L3（＋） group and AFP-L3（-） group.The variations of T-lymphocyte subsets,natural killer T-cells（NK,CD3＋ CD16＋CD56＋）,CD4＋ T-cells（CD3＋ CD4＋）,CD8＋ T-cells（CD3＋ CD8＋）,CD4/CD8 ratio and regulatory T-cells（Treg,CD4＋ CD25＋ Foxp3＋）,were analyzed by flow cytometry.RESULTS： According to the International Union against Cancer（UICC） staging system,29 patients in AFP-L3（＋） group were in stage III and IV,while only 7 patients in AFP-L3（-） group were in stage III and IV.According to the Barcelona Clinic Liver Cancer（BCLC） staging system,20 patients in AFP-L3（＋） group were in stage C and D,while only 3 patients in AFP-L3（-） group were in stage C and D.Seventeen patients in AFP-L3（＋） group suffered vascular invasion,significantly more than those in AFP-L3（-） group.The percentage of NK cells and CD4/CD8 ratio decreased in AFP-L3（＋） group,while the percentages of CD8＋ and Treg cells significantly increased.CONCLUSION： The AFP-L3（＋） patients have liability to vascular invasion and worse tumor stages,which may relate to variations of lymphocyte subsets and suppression of the immune system.