肺癌患者化疗前后外周血淋巴细胞免疫分型及和功能状态评分间的关系

Changes of Lymphocyte Subsets in the Peripheral Blood and Performance Status Before and After Chemotherapy in Patients with Lung Cancer

目的探讨肺癌患者化疗前后免疫功能变化及和功能状态评分间的关系。方法60例初治肺癌患者化疗前、化疗两个周期后分别用流式细胞仪检测的外周血淋巴细胞免疫分型并与20例正常体检者作对照,同时对肺癌患者进行功能状态评分。结果肺癌患者化疗前CD3+、CD4+、NK细胞比例分别为(46.19±8.72)%、(20.57±5.80)%、(17.67±6.53)%,均低于正常对照组[分别是(59.76±6.92)%、(35.89±6.97)%、(21.51±4.64)%],差异有统计学意义(P<0.05),CD8+细胞比例为(28.51±8.21)%,高于正常对照组[(20.93±4.78)%],差异有统计学意义(P<0.05),CD19+细胞比例为(7.54±4.29)%,与正常组[(9.52±4.06)%]相比,差异无统计学意义(P>0.05)。一线两药含铂方案化疗两个周期后,肺癌患者外周血CD3+、CD4+、NK细胞比例分别为(57.96±8.33)%、(33.29±6.90)%、(21.48±5.78)%,较化疗前有增多趋势,差异有统计学意义(P<0.05),而CD8+细胞比例为(21.64±5.10)%,较化疗前减少,差异有统计学意义(P<0.05)。肺癌患者功能状态评分化疗前平均为1.48±0.60,化疗后平均为1.45±0.95,差异无统计学意义(P>0.05)。结论肺癌患者免疫功能较正常人普遍降低,化疗在短期内有可能使肺癌患者免疫水平得到一定程度恢复,检测肺癌患者外周血淋巴细胞免疫分型可作为疗效评估和全身功能状态评分的补充。

Objective To investigate the changes of immune function status and performance status score before and after antineoplastic chemotherapy in patients with lung cancer. Methods Lymphocyte subsets in the peripheral blood were measured by flow cytometry in sixty treatment naive patients with lung cancer and twenty healthy controls. All the parameters were repeated after two cycles of antineoplastic chemotherapy and score changes of the performance status were also determined during the process. Results The percentage of CD3^＋,CD4^＋ lymphocytes and NK cells was （46.19±8.72）%,（20.57±5.80）% and （17.67±6.53）% respectively in treatment naive lung cancer group, lower than that in the control group which was （ 59.76±6.92 ） %, （ 35.89±6.97 ） % and （21.51 ±4.64 ） % respectively （P〈0.05）. The percentage of CD8^＋ cell was （28.51±8.21）%, higher than that in the control group （20.93±4.78） % （P〈 0.05）. The ratio of CD19^＋ cells was （7.54±4.29）%, similar with that in the control group （9.52±4.06）% （P〉0.05）.After two cycles of platinum-based first-line chemotherapy, the ratio of CD3^＋,CD4^＋ and NK ceils was increased to （57.96±8.33）%,（33,29±6.90）%,（21.48±5.78）% respectively, the ratio of CD8^＋ cell was decreased to （21.64±5.10）%, compared with the level before chemotherapy （P〈0.05）.At the same time performance status score was evaluated in patients with lung cancer according to Eastern Cooperative Oncology Group （ECOG） score standards. The average score of patients was 1.48 ±0.60 before chemotherapy,and 1.45 ±0.95 after chemotherapy, which showed no significant statistical difference Conclusion The immune status in patients with lung cancer is generally compromised compared with the healthy control. Application of first-line chemotherapy may restore immune function to a certain extent in a short term. Measuring the changes of lymphocyte subsets in peripheral blood may serve as a supplement to evaluate the efficacy of the chemotherapy and performance status of the patients.