恶性胸腔积液患者T淋巴细胞亚群的变化意义

Value of measurement of T-lymphocyte subsets in patients with malignant pleural effusions

目的:探讨检测恶性胸腔积液(MPE)患者外周血(PB)和胸水(PE)中T淋巴细胞亚群(TLS)的意义及化疗前后TLS的变化.方法:对比良性胸腔积液(BPE)、MPE患者外周血和胸水及健康正常人外周血中TLS的水平;对比MPE患者外周血和胸水中TLS的水平;对比MPE患者化疗前、后外周血和胸水中TLS的水平.结果:TLS在胸腔积液患者外周血和胸水中分布相似;MPE患者外周血中CD8+T细胞水平高于正常人(30.6±2.4vs20.9±1.8,P<0.05),CD4+T细胞相仿,CD4+/CD8+低于正常(1.78±0.21vs2.71±0.35,P<0.05);与BPE患者相比,MPE患者外周血和胸水中CD4+T细胞、CD4+/CD8+较低(P<0.05),而CD8+T细胞较高(P<0.05);化疗后MPE患者外周血和胸水中CD8+T细胞水平明显降低(30.6±2.4vs24.7±2.3,31.6±2.4vs21.9±4.1,P<0.05),CD4+/CD8+明显升高(1.78±0.21vs2.19±0.19,1.69±0.30vs2.62±0.40,P<0.05).结论:检测外周血可以了解胸水中TLS水平;检测外周血和胸水中TLS水平有助于BPE和MPE的鉴别;化疗可部分改善MPE患者的细胞免疫抑制状态.

AIM： To measure T-lymphocyte subsets （TLS） in peripheral blood （PB） and pleural effusion （PE） in patients with malignant pleural effusions （MPE） and to study the changes of TLS in PB and PE in patients with MPE before and after chemotherapy. METHODS： The levels of TLS in PB and PE in patients with MPE or benign pleural effusion （BPE） and in PB of normal person were examined and compared; The levels of TLS in PB and PE were also compared before and after chemotherapy. RESULTS： The distribution of TLS was similar in PB and PE in patients with MPE; the level of CD8^＋ T cell in PB of patients with MPE was higher than that in normal person （ 30. 6 ± 2. 4 vs 20.9 ± 1.8, P 〈0.05）, but the ratio of CD4^＋/CD8^＋ was lower than that in normal person （ 1.78± 0. 21 vs 2.71 ± 0. 35, P 〈 0.05 ）, and the level of CD4^＋ T cell was similar with the normal; compared with BPE patients, MPE ones had lower level of CD4^＋ T cell and ratio of CD4^＋/CD8^＋ （ P 〈 0.05 ）, but higher level of CD8^＋ T cell in their PB and PE （P 〈 0. 05） ; chemotherapy could depress CD8^＋ T cell （30.6 ±2.4 vs 24.7 ±2.3, 31.6 ±2.4 vs 21.9±4. 1, P 〈0.05） and elevate the ratio of CD4^＋/CD8^＋ （1.78 ±0.21 vs 2. 19 ±0. 19, 1.69 ±0.30 vs 2.62±0.40, P〈 0. 05） in PB and PE in patients with MPE. CONCLUSION： The level of TLS in PE can be known by measuring it in PB; it is helpful to measure the level of TLS in PB and PE for distinguishing MPE from BPE; cell-mediated immunity depression in MPE can be partly ameliorated by chemotherapy.