羟基喜树碱和吡柔比星膀胱灌注对膀胱癌患者免疫力的影响比较

Comparative investigation on use of HCPT and THP intravesical instillation on immunological reactivity in patients with transitional cell carcinoma of the bladder

目的:观察羟基喜树碱(HCPT)和吡柔比星(THP)膀胱灌注对膀胱移行细胞癌患者免疫力的影响。方法:临床选择行经尿道膀胱肿瘤电切术(TURBT)或膀胱部分切除术的膀胱移行细胞癌患者54例,随机分为两组,术后分别以HCPT和THP膀胱灌注治疗,于治疗前及治疗1疗程后取患者外周血,流式细胞术测定T细胞亚群分布,ELISA测定血清TGF-β1的水平。结果:膀胱灌注治疗后CD4+T细胞亚群均有显著性升高,HCPT治疗组升高(12.92±5.22)%,THP组升高(10.28±4.15)%,组间对比差异无显著性,两组CD8+T细胞亚群变化不明显。浸润性肿瘤及Ⅲ级肿瘤患者TGF-β1均有显著性下降,组间对比差异无显著性,表浅肿瘤及低分级肿瘤患者TGF-β1无显著性变化。结论:HCPT和THP膀胱灌注可抑制肿瘤免疫逃逸、提高机体免疫力。

Objective To observe the variation of immunological reactivity in patients with transitional cell carcinoma of the bladder after HCPT and THP intravesical instillation. Methods Intravesical instillation of HCPT and THP were administrated randomly in two groups of patients with transitional cell carcinoma of the bladder undergoing TRUBT or partial cystectomy, the variation of peripheral blood T subset and serum transforming growth factor-β1（TGF-β1） were monitored with flow cytometer assays and ELISA respectively. Results After one course of the therapy with HCPT and THP, CD4^＋ T subsets in peripheral blood was （12. 92 ±5.22）% and （10.28 ±4. 15）% respectively, whereas no significant variation was observed in CD8^＋ T subsets. TGF-β1 decreased significantly in patients with invasive and high grade bladder cancer, but there was no significant difference between two groups. Conclusion HCPT and THP intravesical instillation could prevent tumors from escaping immunosurveillance and improve the general immunological reactivity.