进展期胃癌患者手术前后免疫状态的对比研究

COMPARATIVE STUDY OF PREOPERATIVE AND POSTOPERATIVE IMMUNE STATUS IN PATIENTS WITH ADVANCED GASTRIC CANCER

为阐明胃癌根治术中联合切脾与否对机体整体免疫状态所起的影响,本文对比 AGC 患者R^+_2(保脾)与 R_3(切脾)根治术后外周血中 NK 细胞活性与 T 细胞亚群值的变化。结果表明:(1)与正常人相比,AGC 患者的术前 CD_8^+细胞值明显升高,而 NK 细胞活性、CD^+_3、AD^+_4、CD^+_4/CD^+_8细胞比值均显著降低(P<0.05～0.001)。(2)R^+_2或 R_3患者术后的 NK 细胞、CD_4^+细胞及 CD_4^+/CD_8^+细胞比值均见明显回升(P<0.05～0.005),但 R_3者的CD_8^+细胞值亦同时有明显的下降(P<0.01)。(3)作 R_2^+或 R_3者术后近期或远期 NK 细胞活性与 T 细胞亚群值均无差异(P>0.1～0.5)。提示 AGC 患者的免疫功能因有肿瘤负荷存在而受到明显抑制;切除病灶可对机体正性免疫功能的恢复起决定性作用;如属必要,于 AGC 患者作联合脾脏切除对整体免疫状态并无明显的不利影响。

In order to elucidate the impact of accompanying splenectomy on the immune statusof AGC patients following radical gastrectomy,comparison of changes in postoperativeNK activity and T-cell subsets was made between R_2^+(without splenectomy,n=45)and R_3 patients(with splenectomy,n=45))who were closely matched in terms of age,sex,location of tumor,TNM staging and time of operation.The results showed:(1)As compared with normal controls,CD_8^+ cells were significantly increased,while theNK activity,CD_3^+ cells,CD_4^+ cells and CD_4^+/CD_8^+ ratio were significantly depressed inAGC patients(P<0.05～0.001).(2)As compared to their respective preoperativevalues,the NK activity,CD_4^+ cells and CD4_4^+/CD_8^+ ratio were significantly elevated bothin R_2^+ and R_3 patients(P<0.05～0.005),in contrast,a striking decline in CD_8^+ cellswas found only in R_3 cases(P<0.01).(3)During the early postoperative(10～14days)as well as the late postoperative(2～4 years)period,no significant difference(P<0.1～0.5)was found in NK activity and T-cell subsets between R_2^+ and R_3 cases.These results imply that the immune function is strongly depressed in AGC patientsbecause of their heavy tumor burden;a complete tumor remorval would play a decisiverole in the restoration of the patient's immune status;if indicated,splenectomy willnot cause any deleterious effect on the immune function in AGC patients.