动脉栓塞联合冷冻消融对晚期肾癌患者免疫功能的影响

Effect of Transcatheter Arterial Renal Embolization Combined with Cryoablation on Immunological Function of Patients with Advanced Renal Carcinoma

目的探讨选择性肾动脉栓塞术(transcatheter renal arterial embolization,TRAE)联合氩氦冷冻消融治疗对晚期肾癌患者外周血CD4+、CD25+调节性T细胞(Treg)的影响及临床意义。资料与方法晚期肾癌患者44例,分别于治疗前、后1～6个月取外周血,流式细胞仪检测外周血T淋巴细胞亚群(CD3+T、CD4+T、CD8+T、CD4+T/CD8+T、NK细胞、Treg细胞)变化情况;术后1个月采用增强MRI或CT或正电子发射体层摄影(PET-CT)评价肿瘤坏死情况。结果治疗后3个月Treg细胞比例[(3.36±1.12)%]与术前[(4.75±1.66)%]比较明显降低,差异具有统计学意义(t=16.865,P<0.01);CD3+T、CD4+T、CD4+T/CD8+T、NK细胞比例较术前明显增高,CD8+T细胞比例明显降低(P<0.01)。治疗后3～6个月CD3+T、CD4+T、CD4+T/CD8+T、NK、CD8+T、Treg细胞比例无明显变化,呈稳定趋势(P>0.05)。治疗后Treg细胞比例下降程度与肿瘤负荷下降程度呈正相关(r=0.944,P<0.01)。结论晚期肾癌患者经TRAE联合氩氦冷冻消融治疗后外周血T淋巴细胞亚群分布异常得到改善,Treg细胞比例变化与肿瘤负荷大小有关。

Objective To analyze the effect of transcatheter renal arterial embolization（TRAE） combined with Argon-Helium cryosurgery （AHCS） on the differentiation of regulatory CD4＋ CD25＋T cell （Treg） and its implication in patients with advanced renal carcinoma.Materials and Methods Peripheral venous blood samples were obtained from 44 patients with advanced renal carcinoma before and after TRAE combined with AHCS at 1months to 6 months. The percentage of Treg cells and T lymphocyte subsets （CD3＋T,CD4＋T,CD8＋T,CD4＋T/CD8＋T,and NK cells） in the peripheral blood was measured by flow cytometry. The necrosis of tumor was observed by enhancement CT,MRI,PET-CT 1 months after TRAE combined with AHCS.Results After TRAE combined with AHCS,The percentages of Treg cells were decreased （P0.01）.the percentages of CD3＋T,CD4＋T,NK and CD4＋T/CD8＋T were significantly increased after TRAE combined with AHCS （P0.01）,and the percentage of CD8＋T cells was significantly decreased （P0.01）.Correlation analysis showed that the decrease of tumor load was positively correlated with the decrease of the percentage of Treg cells （r=0.994,P0.01）.Conclusion After TRAE combined with AHCS,the abnormal distribution of subsets of T-lymphocytes can be improved. The percentage of Treg cells is correlated with tumor load.