原发性肝癌介入治疗后机体免疫功能的研究

Changes of Cellular Immunity after Interventional Treatment of Hepatocellular Carcinoma

目的探讨经动脉化疗栓塞(TACE)治疗后碘油(LP)和化疗药物剂量对原发性肝癌患者细胞免疫功能的影响。方法36例经病理证实的原发性肝细胞癌(HCC)患者,随机分为A、B、C三组分别行TAE或TACE治疗,A组(n=12)单纯行TAE治疗,LP用量(ml)约等于肿瘤直径(cm);B组(n=12)应用LP和小计量化疗药物,LP用量同前,吡柔比星(THP)10mg,丝裂霉素(MMC)4mg;C组(n=12),LP用量同前,化疗药物为常规用量(THP50mg,DDP60mg,MMC10mg),治疗前和治疗后一个月用流式细胞仪检测患者外周血CD3+、CD4+、CD8+、CD4+/CD8+、NK。结果治疗前各组间细胞亚群无显著差异(P>0.05),治疗后A、B两组CD3+、CD4+、NK细胞活性明显高于治疗前)(P<0.05)CD8高于治疗前(P<0.05),两组间治疗后无显著性差异(P>0.05);C组治疗后CD3、CD4、NK细胞活性较治疗前明显降低(P<0.05),CD8+明显高于治疗前(P<0.01)。结论大剂量化疗药物应用可抑制机体的细胞免疫功能,小剂量化疗药物联合应用适量LP可提高机体的细胞免疫动能。

Objective To study the effect of transcatheter arterial chemoembolization(TACE) on cellular immunity function in patients with hepatocellular carcinoma(HCC). Methods 36 cases of HCC confirmed by pathology were randomly divided into three groups. A group(n=12) was treated by transcatheter arterial embolization(TAE), and the dosage(ml) of LP was about equal to the diameter(cm) of tumor. B group(n=12) was treated by TACE, the dosage of LP was same as A group, and the dosage of THP and MMC was 10mg and 4mg, respectivley. C group(n=12) was also treated by TACE, and the dosage of THP, DDP and MMC was 50mg, 60mg and 10mg, respectively. The number of T cell subsets(CD_3^+,CD_4^+,CD_8^+, and CD_4^+/CD_8^+), and NK before and one month after TACE treatment was determined using flow cytometry. Results T cell subsets had no obvious difference before TACE treatment among three groups(P>0.05). In both A and B groups the number of CD_3^+, CD_4^+, CD_8^+ T cells and NK was signficantly higher after treatment than before treatment(P<0.05), and it was not significantly different after treatment between A and B groups(P>0.05). The amount of CD_3^+,CD_4^+ T cells and NK was obivously lower after treatment than before treatment in C group, and CD_8^+ T cells amount significantly increased after treatment compared with before treatment(P<0.01). Conclusion A large dosage of chemotherapy inhibited the cellular immunity function of the patients with HCC, and the application of small dosage of chemotherapy combined with suitable dosage of LP could increase the cellular immunity function of the patients with HCC.