T3期大肠癌患者新辅助化疗与手术前后外周血T细胞亚群变化的研究

A Study on Changes of T-lymphocyte Subsets in T3 Stage Patients with Colorectal Carcinoma before and after Neoadjuvant Chemotherapy and Surgery

目的:探讨T3期大肠癌患者新辅助化疗与手术前后外周血T细胞亚群免疫功能的变化规律。方法:入组56例T3期大肠癌患者,以奥沙利铂为主的新辅助联合化疗后行根治性手术,采用流式细胞术检测新辅助化疗前1天、术后第7天及术后14天外周血中T细胞亚群免疫功能(CD3+、CD3+CD4+、CD3+CD8+、CD4+/CD8+)的变化规律。并与50例健康对照组比效。结果:T3期大肠癌患者新辅助化疗前外周血T细胞亚群免疫功能低于正常对照组,但差异无统计学意义(P>0.05);T3期大肠癌患者新辅助化疗及手术后7天外周血T细胞亚群免疫功能明显低于未治疗前患者,差异有统计学意义(P<0.01);T3期大肠癌患者新辅助化疗及手术后14天外周血T细胞亚群免疫功能稍低于未治疗前患者,但差异无统计学意义(P>0.05)。结论:T3期大肠癌患者细胞免疫功能低下,经新辅助化疗与手术后1周细胞免疫功能进一步下降,但术后2周细胞免疫功能已恢复接近至治疗前水平。提示T3期大肠癌患者经新辅助化疗与手术治疗前后免疫功能呈U形的变化规律,能为临床根据细胞免疫功能更好地进行大肠癌的综合治疗提供理论依据。

Objective： To explore the trends of peripheral T-lymphocyte subsets in T3 stage patients of colorectal carcinoma before and after neoadjuvant chemotherapy and operation.Methods： Fifty-six T3 stage patients of colorectal carcinoma were included in the treatment group with a control group of fifty normal persons without colorectal carcinoma.All the 56 patients received neoadjuvant chemotherapy with oxaliplatin and radical surgery.The levels of peripheral T-lymphocyte subsets were tested on the day before neoadjuvant chemotherapy,seven days and fourteen days after operation by flow cytometry.Results of the two groups were compared.Results： The immune function of peripheral T-lymphocyte subsets before neoadjuvant chemotherapy in the treatment group was lower than that in the control group.However,the difference was not significant（P value 0.05）.The immune function of peripheral T-lymphocyte subsets seven days after operation was lower than that before treatment with significant difference（P0.01）.The immune function of peripheral T-lymphocyte subsets fourteen days after operation was a little bit lower than that before treatment without significant difference（P0.05）.Conclusion： Cellular immune function in T3 stage patients was low.It decreased more in one week after operation and neoadjuvant chemotherapy.However,it would turn to be almost the same level of that before treatments.The study showed that the immune function in T3stage patients with colorectal carcinoma changed with U-shape trend.It might be a useful theory for choosing better comprehensive treatment for colorectal carcinoma according to cellular immune function.