食管、贲门癌围手术期细胞免疫功能动态变化的临床研究

The Perioperative Cellular Immunity Functional Changes and Feasibilityof Biotherapy in Esophageal and Cardiac Cancer

目的 :探讨食管、贲门癌全身、局部细胞免疫功能状态及生物治疗的可行性。方法 :采用免疫组化观察分析50例食管、贲门癌局部肿瘤浸润淋巴细胞 (TIL)、肿瘤相关性巨噬细胞 (TAM)的分布特征 ,采用ELISA法和硝酸还原酶法分别对体内可溶性白细胞介素2受体 (sIL -2R)表达和一氧化氮 (NO)生成水平进行动态检测。结果 :1)癌周TIL、TAM的浸润密度大于癌巢间质 (P<0.05) ;2)术前血清sIL -2R水平高于正常对照组 (P<0.001) ,根治术后sIL -2R较术前明显下降 (P<0.001) ,有淋巴结转移者其术前sIL -2R较无转移者明显升高 (P<0.05) ;3)术前血清NO水平低于正常对照组 (P<0.05) ;癌周组织匀浆NO含量高于癌组织NO含量(P<0.05) ,在癌侵及肌层时更为明显(P<0.001) ;癌周组织匀浆NO含量与浸润MΦ数量正相关 (P<0.001)。结论 :1)恶性肿瘤患者免疫抑制是肿瘤源性的 ,可能与肿瘤细胞在增殖过程中释放一些免疫抑制因子有关 ,根治切除肿瘤则有益于改善患者的细胞免疫功能状态 ;2)食管。

Objective: To probe into the state of systemic and local cellular immunity function in esophageal and cardiac cancer patients and the feasibility of biotherapy. Methode: Fifty cases were studied with immunohistochemistry to analyse the distribution pattern of local tumor-infiltrating lymphocytes (TIL) and tumor-associated macrophages (TAM). With ELISA and nitrate reductase, we carried out dynamic observation of the expression levels of sIL-2R and NO. Results:1) The infiltration density of the peripheral portion of cancer stroma showed greater than that of cancer nest interspace. 2) The serum level of sIL-2R before operation was higher than that of the healthy controls (P< 0.001), significantly lowered after radical resection (P< 0.001). The sIL-2R level of those with lymph node metastasis were obviously higher than those without metastasis (P< 0.05). 3) The serum level of NO before operation was lower than that of the healthy control (P< 0.05).The homogenate of pericarcinous tissues contained a higher levels of NO than those of carcinous tissues (P< 0.05) and it was more obvious when the muscularis was invaded (P< 0.001). The NO level in the homogenate of pericarcinous tissues had a positive correlation with the infiltrated MΦ density (P< 0.001). Conclusion: 1) The immunosuppression of the malignant tumor originated from the tumor which related with the tumor derived immunosuppressive factor from tumor cells. The necessity of removal of tumor may improve the systemic cellular immunity state of patients. 2) It is essential to provide early supplementary treatment with suitable biotherapy after operation.