化疗对胃癌患者免疫功能的影响

Effect of Chemotherapy on Immunologic Function in Patients with Gastric Cancer

背景:化疗药物可杀灭或抑制胃癌患者的肿瘤细胞,同时亦影响患者机体的免疫状态。分析胃癌患者化疗前后免疫状态的变化有助于准确实施化疗和综合治疗。目的:探讨化疗对胃癌患者免疫功能的影响。方法:共63例接受化疗的胃癌患者入选,化疗前后分别应用流式细胞仪和酶联免疫吸附测定(ELISA)检测外周血T细胞亚群和血清可溶性白细胞介素-2受体(sIL-2R)水平,并设健康者作为正常对照组。结果:胃癌患者化疗前CD3+、CD4+T细胞数以及CD4+/CD8+比值显著低于正常对照组(P<0.05),血清sIL-2R水平显著升高(P<0.05)。化疗后1周胃癌患者CD3+、CD4+T细胞数、CD4+/CD8+比值较化疗前显著降低(P<0.05),血清sIL-2R水平显著升高(P<0.05);化疗后3周,上述指标逐渐恢复,与化疗前水平相比无明显差异,但与正常对照组相比差异仍有统计学意义(P<0.05)。化疗过程中最常见的不良反应为恶心、呕吐(68.3%)和骨髓抑制(46.0%)。结论:胃癌患者在短期化疗后出现的免疫功能抑制需3周以上才能明显恢复。应于化疗早期使用免疫增强调节剂,以利于实施有效的综合治疗。

Background： The bottleneck of chemotherapy has shown that not only malignant cells but also many normal immune cells are destroyed or inhibited. Analysis of the effect of chemotherapy on immunologic function in patients with gastric cancer will be beneficial for appropriate chemotherapy and combined therapy. Aims： To assess the effect of chemotherapy on immunologic function in patients with gastric cancer. Methods： Sixty-three gastric cancer patients treated with chemotherapy were enrolled. Levels of peripheral blood T lymphocyte subsets and serum soluble interleukin-2 receptor （slL-2R） were determined before and after chemotherapy by flow cytometry and enzyme-linked immunosorbent assay （EILSA）, respectively. Healthy subjects were served as normal controls. Results： Before chemotherapy, numbers of CD3^＋ T cell, CD4^＋ T cell, and CD4^＋/CD8^＋ ratio in gastric cancer patients were significantly lower than those in normal controls （P〈0.05）, serum level of sIL-2R was markedly higher than that in normal controls （P〈0.05）. One week after chemotherapy, numbers of CD3^＋ T cell, CD4^＋ T cell, and CD4^＋/CD8^＋ ratio decreased obviously and serum level of sIL-2R increased significantly in gastric cancer patients than those before chemotherapy （P〈0.05）. Three weeks after chemotherapy, all indexes gradually recovered to the levels before chemotherapy, but still had statistically significant differences when compared with those of normal controls （P〈0.05）. The most common adverse effects occurred during the chemotherapy were nausea/ vomiting （68.3%） and bone marrow suppression （46.0%）. Conclusions： Immunologic function suppression after short term chemotherapy in gastric cancer patients can recover significantly after a period of 3 weeks or longer. Immunoenhancement measures should be taken during the early stage of chemotherapy, and it may be beneficial for the combined therapy of gastric cancer.