肝癌射频消融与手术切除对机体抗肿瘤免疫状态的影响

Effect of radio frequency ablation and operation on immunity of anti-tumor in primary hepatocellular carcinoma

目的比较射频消融与手术切除两种治疗对原发性小肝癌组织的清除效果及外周血免疫细胞和细胞因子变化的影响。方法将原发性小肝癌患者83例,分为手术组34例,行肝癌根治术治疗;射频消融组49例,行经皮肝穿刺射频消融治疗。ELISA法检测两组患者治疗前后血清中AFP及Th1型细胞因子(IL-2、IFN-γ)、Th2型细胞因子(IL-4、IL-10)的变化情况,并用流式细胞仪检测外周血中CD4+、CD8+、CD4+CD25+Treg、NK1.1细胞的比例变化。结果手术组与射频组治疗后血清AFP含量均有明显下降,与术前比较有统计学意义(P<0.05),但两组间下降差值比较无统计学意义(P>0.05);两组治疗前后血清IL-4、IL-10含量无明显变化;射频组治疗后血清IL-2和IFN-γ含量增高,与治疗前比较有统计学意义(P<0.05),而手术组此项比较无统计学意义(P>0.05)。射频组治疗后CD4+T细胞和NK1.1细胞比例增高,CD8+T细胞和CD4+CD25+Treg细胞比例明显降低,与治疗前相比均有显著性差异(P<0.05)。手术组和射频组CD4+/CD8+比值比较,有显著性差异(P<0.01),射频组比值明显升高。结论射频消融在清除小肝癌瘤体的作用方面与手术切除治疗无明显差异,但在促进Th1/Th2细胞因子比例向Th1型偏移,增强机体抗肿瘤细胞免疫功能的作用方面强于手术切除治疗。

Aim To study the different effects of radio frequency ablation（RFA） and surgical resection of primary hepatocellular carcinoma on the proportion of immunocytes and cytokine secreting in the peripheral blood.Methods Eighty-three patients were divided into two groups,one group（49 cases） treated with RFA and the other group（34 cases） treated with operation.Before and after the treatment,the percentage of CD4^＋ T cells,CD8^＋ T cells,NK1.1 cells and CD4^＋CD25^＋ Treg cells of peripheral blood,and the concentration of IL-2,IFN-γ,IL-4 and IL-10 of plasma were determined with flow cytometry and ELISA,respectively.Results After RFA and operation treatment,AFP of the two groups decreased（P〈0.05）,but the degree of AFP decline between two groups was not obviously different（P〉0.05）.IL-4 and IL-10 were not obviously different（P〉0.05）.The concentration of IL-2 and IFN-γ of the RFA group increased after treatment（P〈0.05）.The rate of CD4^＋ T cells and NK1.1 cells in the RFA group increased,and the rate of CD8^＋ T cells and CD4^＋CD25^＋ Treg cells decreased.The levels of CD4^＋/CD8^＋ were significantly different between the RFA group and operation group after the treatment（P〈0.01）.Conclusion The curative effects of RFA and operation have no difference.But RFA may induce Th2/Th1 deviation and markedly enhances the cellular immune function,while surgical resection decreases the cellular immune function.