消化系癌血清微量元素与T细胞亚群相关性研究的价值

Correlation between trace elements and T cell subsets in digestive system cancer and its clinical significance

目的探讨消化系癌血清微量元素与Ｔ细胞亚群关系的临床意义．方法用原子吸收分光光度法测定食管癌３１２例和健康人１００例血清Ｚｎ，Ｃｕ，Ｆｅ，Ｍｎ，Ｃａ．４８例癌患者和健康人外周血Ｔ细胞亚群用间接免疫荧光法测定．结果消化系癌患者血清中Ｃｕ含量，Ｃｕ／Ｚｎ比，ＣＤ８＋显著高于健康人（Ｐ＜００１）；Ｚｎ，Ｃａ含量，ＣＤ３＋，ＣＤ４＋，ＣＤ４＋／ＣＤ８＋比值明显低于健康人（Ｐ＜００５～Ｐ＜００１）；Ⅲ～Ⅳ期及转移癌患者Ｃｕ含量，Ｃｕ／Ｚｎ比，ＣＤ８＋明显高于Ⅰ～Ⅱ期癌患者（Ｐ＜００５～Ｐ＜００１）．直线相关分析表明：血清Ｃｕ，Ｃｕ／Ｚｎ比值与ＣＤ４＋，ＣＤ４＋／ＣＤ８＋比成负相关，Ｚｎ与ＣＤ４＋／ＣＤ８＋比成正相关（Ｐ＜００５）．多因素Ｌｏｇｉｓｔｉｃ回归分析表明，Ｃｕ，Ｃｕ／Ｚｎ比升高，发生消化系癌的相对危险度升高；Ｚｎ，Ｃａ含量升高，发生消化系癌相对危险度降低．结论对消化系癌患者适量补Ｚｎ，调节和改善宿主抗肿瘤免疫力；Ｃｕ／Ｚｎ比对消化系癌阳性诊断率为７０％，特异性为７３％．因此，Ｃｕ／Ｚｎ值可做为消化系癌的一项诊断指标。

AIM To study the correlation between trace elements (TE) and T cell subsects (CD+T) in digestive system cancer and its clinical significance. METHODS Serum zinc, copper, iron, manganese, calcium levels were determined in 312 patients with digestive system cancer and 100 healthy subjects by atomic absorption spectrophotometry. The T cell subsects were measured in 48 patients and healthy subjects by indirect immunofluorescence method. RESULTS In patients with digestive system cancer serum copper, copper/zinc ratio, CD8 + were significantly higher, and zinc, calcium, CD3 +, CD4 +, CD4 +/CD8 + were significantly lower than that in healthy subjects respectively ( P <0 01). Patients in stage Ⅲ-Ⅳ and with metastatic cancers had much higher copper level, copper/zinc ratio, CD8 +, and much lower zinc, CD4 +, CD4 +/CD8 + than patients in stage Ⅰ-Ⅱ, respectively ( P <0 05- P <0 01). Linear correlation analysis showed that serum copper, Cu/Zn ratio had negative correlation with CD4 + and CD4 +/CD8 +, and zinc had positive correlation with CD4 +/CD8 + respectively ( P <0 05- P <0 01). Multi variable logistic regression analysis showed that serum copper, Cu/Zn ratio elevation might be the dangerous risk factors, and serum zinc and calcium might have certain protective effect against digestive system cancers. CONCLUSION Suitable Zn supplementation for digestive system cancer patients can enhance cell mediated immunity against neoplasms. Cu/Zn ratio has a sensitivity of 70%,and specificity of 73% in the diagnosis of digestive system cancer. So Cu/Zn ratio plays an important role in screening primary digestive system cancer from high risk population.