食管癌、贲门癌患者围术期外周血T细胞亚群、sIL-2R、TNF-β动态观测及相关因素研究

The Study About the Changes and Related Factor in Peripheral Blood T Lymphocyte Subsets and sIL-2R and TNF-β in Perioperative Period Patients with Esophageal Carcinoma and Cardiac Carcinoma

目的 探讨食管癌、贲门癌患者围术期外周血T淋巴细胞亚群、sIL - 2R、TNF - β改变的规律性、相关因素及临床意义。方法 应用SAP法、ELISA法及ABC -ELISA法分别检测 32例食管癌、2 2例贲门癌患者术前、术后 1、2、3周外周血T淋巴细胞亚群、sIL - 2R及TNF - β表达 ,并将所得结果与正常对照组作对比研究。 结果 与正常对照组比较 ,食管癌、贲门癌患者外周血CD3+、CD4+明显减少 ,而CD8+明显增加 ,CD4+/CD8+比值明显下降 (P <0 .0 1) ,sIL - 2R及TNF - β水平明显升高 (P <0 .0 1)。患者免疫功能损害程度与肿瘤TNM分期相关。手术创伤使机体免疫功能在术后短期内受到抑制。Ⅲ期手术探查组患者与同期手术根治组患者比较 ,sIL - 2R及TNF - β水平显著增加 (P <0 .0 1)。结论 食管癌、贲门癌患者存在细胞免疫功能紊乱 ,并与肿瘤的TNM分期相关。手术创伤可引起暂时性免疫抑制。动态检测食管癌、贲门癌患者外周血T淋巴细胞亚群、sIL - 2R及TNF - β表达对评估患者的细胞免疫功能。

Objective The aim of this study was to evaluate the clinical implication of the changes and related factor in peripheral blood T lymphocyte subsets and sIL-2R and TNF-β during the perioperative period of esophageal carcinoma and cardiac carcinoma.Methods The 32 patients underwent esophagectomy and 22 patients cardiectomy served as experimental subjects, and 22 health persons as the controls. Blood samples were withdrawn from peripheral vein before operation, and 7, 14, 21 days after operation. Using SAP, ELISA and ABC-ELISA, T lymphocyte subsets and serum sIL-2R and TNF-β were determined.Results Peripheral blood CD3 +, CD4 +, CD4 +/CD8 + ratio in the preoperative patients were lower than that in the control group ( P <0.01). CD8 +, serum sIL-2R and TNF-β were higher in preoperative patients ( P <0.01 ) . The variation in CD3 +, CD4 +, CD4 +/CD8 +, sIL-2R and TNF-β were specially obvious 7 days after operation ( P <0.01 ) .The serum sIL-2R and TNF-β in the tertiary exploratory group were obviously higher than that in the tertiary radical group ( P <0.01 ).Conclusion There are immune disturbances in the patients with esophageal carcinoma and cardiac carcinoma. The disturbances are closely related to the TNM stage of carcinoma. Surgical trauma was able to aggravate the immune disturbances of the patients in a short span of time. Dynamic determination of T lymphocyte subsets and serum sIL-2R and TNF-β level could the immune stage of the patients, direct therapy , evaluate the operative therapeutic effects and provide the theoretical basis for patient's immune treatment.