大肠癌患者围手术期免疫状态变化的临床意义

Significance of the changes of perioperative immune status in colorectal cancer patients

目的研究大肠癌患者围手术期的免疫状态。方法应用APAAP夹心法ELISA和比色法分别测定大肠癌患者手术前后T细胞亚群变化、血浆可溶性白介2受体(sIL-2R)及一氧化氮(NO)和癌组织的sIL-2R、NO含量。结果大肠癌患者手术前CD3、CD4细胞、CD4/CD8比值和血浆NO水平明显低于正常,血浆sIL-2R、CD8细胞较正常显著增高,肿瘤切除后3周左右CD3、CD4细胞、CD4/CD8和血浆NO较术前有明显升高,sIL-2R和CD8细胞较术前降低,术后T细胞亚群、sIL-2R和NO水平接近正常对照组;大肠癌患者T细胞亚群、sIL-2R和NO与大肠癌Dukes临床分期有关;大肠癌组织中sIL-2R、NO含量显著高于癌旁组织。结论恶性肿瘤患者机体免疫受到抑制,切除肿瘤后全身免疫机能状况改善,测定肿瘤患者的T细胞亚群和血浆sIL-2R、NO能够较好地反映机体的免疫状况,并可为判断大肠癌病情和指导临床治疗提供有价值的参考资料。

ObjectiveTo evaluate the perioperative immune status of patients with colorectal cancer(CRC).MethodsThe plasma levels of soluble interleukin 2 receptors(sIL 2R),nitric oxide(NO)and T lymphocyte subsets were determined from 45 CRC patients and 30 healthy controls by sandwich ELISA,colorimetry and APAAP respectively.NO and sIL 2R in CRC and paracancerous tissues(PTC)of 15 patients were also tested.ResultsCD3 cells,CD4 cells,CD4/CD8 ratio and plasma NO were significantly lower in CRC patients before operation than those in the controls,while the CD8 cells,plasma sIL 2R were much higher in cancer patients.The CD3 cells,CD4 cells,CD4/CD8 ratio as well as plasma NO increased remarkably postoperatively,while the CD8 cells and plasma sIL 2R decreased.Furthermore,these data were related with CRC Dukes stages,sIL 2R and NO in cancer tissue were higher significant than those in paracancerous mucosa tissue.ConclusionsThe immune status of CRC patients was somewhat depressed and closely related with Dukes stage,after curative or palliative resection,the cellular and humoral immunity both improved.Measurement the T lymphocyte subsets,plasma sIL 2R and NO can show the immune status,and may be beneficial to guide adjuvant therapy. [