全量放疗对老年食管癌患者T细胞亚群与循环、呼吸的影响

Effect of full dose adiotherapy on cardiorespiratory function and T-lymphocyte subtype of patients with presby-esophagus carcinoma

目的探讨根治性手术和根治性放疗2种方法对老年食管癌患者T细胞亚群与循环、呼吸的影响。方法采用食管癌生命质量测定量表EORTCQES-24(V3.0)调查了治疗后1年存活且无复发及转移的患者中,分别接受根治量放疗(放疗组,10例)和根治性手术(手术组,9例)治疗后1年内的中期食管癌患者围手术期生命质量,采用FACSCanto测定2组各时间点T淋巴细胞亚群和观察各时间点平均动脉压(MAP)、心率(HR)、潮气量(VT)、肺活量(VC)、呼吸频率(RR)和脉搏氧饱和度(SpO2)的变化。结果FACSCanto检测2组外周血T细胞亚群,2组治疗后24hCD3+、CD4+、CD8+、CD4+/CD8+均明显下降;手术组术后第3天淋巴细胞亚群基本恢复,放疗组治疗后24h和第3天CD3+、CD4+、CD8+、CD4+/CD8+细胞比率较手术组下降明显(P<0.05),并且持续至治疗后第7天,但在治疗后第14天恢复正常并与手术组无明显差异(P>0.05);2组间的MAP、HR、VT、VC、RR和SpO2的变化有显著性差异(P<0.05),手术组术后围术期循环指标的变化和呼吸指标的变化明显低于放疗组。结论与放疗组相比,手术组围手术期时的生命质量降低,根治量放疗不仅符合现代的生理?心理?社会医学模式,而且也解决了某些不具备手术适应证或主观拒绝手术治疗的食管癌患者。

Objective To explore the effect of radical surgery and radical radiation therapy on cardiorespiratory function and T-lymphocyte subtype of patients with esophagus carcinoma. Methods Forty patients with no recurrence and metastases were assessed by the quality of life of esophageal carcinoma EORTCQES 24 （V3.0）. The quality of life of patients with esophageal carcinoma undergoing radical radiation therapy （radiotherapy group, 10 cases） or radical surgery （surgery group,9 cases） was analyzed 1 year after therapy. FACSCanto was used to detect the T-lymphocyte subtype. The changes of MAP, HR, VT, VC, RR, SpO2 were observed in different time pot. Results The levels of CD3^＋ , CD4^＋ , CD8^＋ , CD4^＋/CD8^＋ decreased significantly in two groups 24 hours after therapy. The function of T-lymphocyte subtype of surgery group recovered 3 days after therapy. The levels of CD3^＋ , CD4^＋ , CD8^＋ , CD4^＋/CD8^＋ cells of radiotherapy group were significantly lower than those of surgery group （P 〈 0. 05 ） from the first post-therapeutic day to the 7th post-therapeutic day. There were no significant differences in the changes of MAP, HR, VT, VC, RR and SpO2 between the two groups（P 〈 0. 05） ,but no significant differences in circulation and respiratory parameters. Conclusions The radical radiation therapy is consistent with the mode of physio-psychosocial medicine and also solves the problem of some esophageal carcinoma patients who do not have the indication of surgery or refuse sugery.