外周血单个核细胞采集术对肿瘤患者淋巴细胞亚群影响的观察

Effects of the collection of peripheral blood mononuclear cells by cytapheresis on lymphocyte subsets from malignant tumor patients

目的：4g讨血细胞分离机采集恶性肿瘤患者外周血单个核细胞（简称“单采”）对机体淋巴细胞亚群的影响。方法：采用流式细胞术（flow cytometry，FCM）检测105例恶性肿瘤患者（I～Ⅲ期30例，Ⅳ期75例）单采前后和30名正常对照者外周血淋巴细胞亚群。结果：I～Ⅲ期肿瘤患者CD4’细胞比例为（31．4±10．4）％，对照组为（39．6±6．3）％，差异有统计学意义，P=0．002；I--Ⅲ期肿瘤患者CD3’CD56’细胞比例为（9．9士6．O）％，对照组为（13．4±5．7）％，差异有统计学意义，P=0．026；I～Ⅲ期肿瘤患者CD4’／CD8’比值为1．2±0．7，对照组为1．6±0．4，差异有统计学意义，P=0．012。Ⅳ期肿瘤患者CD3’细胞比例为（64．0±9．3）％，CD4’为（28．4±9．2）％，CD4’／CD8’比值为1．1±0．6，与对照组比较均下降，P值均〈O．001。I～Ⅲ期肿瘤患者CD8’细胞比例为（30．5±11．6）％，IV期为（29．1±10．1）％，I～Ⅲ期CDl9’为（14．O±8．6）％，Ⅳ期为（17．4±8．3）O，I～Ⅲ期CD4-‘CD25’为（3．8±1．6）％，Ⅳ期为（5．5±2．7）％，与对照组比较均上升，P值均〈0．05。恶性肿瘤患者单采后第1天与单采前相比，淋巴细胞及单核细胞数下降，P值分别为0．048和0．035，血小板下降显著，P〈0．001；单采后第3天与单采前相比，血常规各项指标无差异，淋巴细胞亚群中CD4’／CD8’比值略有下降，但差异无统计学意义，P=0．412；其余指标差异无统计学意义。结论：恶性肿瘤患者细胞免疫功能低下，随临床分期增加愈发明显；单采对恶性肿瘤患者血常规及细胞免疫影响是有限的。

OBJECTIVE：To investigate effects of the collection of peripheral blood mononuclear cells by blood cell separator on lymphocyte subsets from malignant tumor patients （＂cytapheresis＂ or ＂apheresis＂ for short）. METHODS： The lymphocyte subsets before and after apheresis in peripheral blood from 105 malignant tumor patients （30 patients in stageI--m, 75 patients in stage IV） and 30 healthy controls were measured by flow cytometry. RESL1LXS： The percentage of CIN＋ ,CD56＋ and ratio of CD4＋/CD8＋ in peripheral blood of malignant tumor patients in stageI--Ⅲ were significantly lower than those of healthy controls, （39.6 ±6.3）% vs （31.4±10. 4） %（P=0. 002） ;（13.4±5.7）% vs （9.9±6.0） （P=0. 026） ;（1.6±0.4） vs （1.2±0.7） ,P=0. 012. The percentage of CD3＋ ,CD4＋ and ratio of CD4＋/CD8＋ of malignant tumor patients in stage IV were （64. 0±9.3）%,（28. 4±9. 2）% and （1.1± 0. 6）,they were significantly lower than those of healthy controls（all P〈0. 001）. The percentage of CD8＋ ,CD19＋ ,CIN＋ CD25＋ of malignant tumor patients in stageI--Ⅲ were （30.5±11.6）%,（14.0±8.6）% and （3.8±1.6） in stage Ⅳwere （29. 1±10. 1）%, （17. 4±8.3）% and （5.5±2.7）% ,which were significantly higher than those of healthy controls （all P〈0. 05）. The amounts of pe ripheral blood lymphocytes and monocytes of malignant tumor patients on day 1 post-apheresis were significantly lower than those before apherisis （P=0. 048,P=0. 035）. The amounts of platelets in peripheral blood decreased obviously （P〈0. 001）. There was no significant difference in the result of blood routine examination between pro-apherisis and post-apheresis day 3. The ratio of CD4＋ / CD8＋ decreased slightly without significant difference on day 3 post-apheresis compared with that before apheresis （P=0. 412）. The rest indexes of lymphocyte subsets had no significant difference. CONCLUSIONS： Cell immune function of malignant tumor patients decreases and becomes more obvious along with the increase of clinical staging. Effects of cytapheresis on blood routine and lympho cyte subsets of malignant tumor patients are limited and acceptable.