R-CHOP方案对淋巴瘤患者免疫球蛋白及T细胞亚群的影响

Measurement of immunoglobulin and T lymphocyte subsets in patients with lymphoma treated with R-CHOP regimen

目的:检测B细胞非霍奇金淋巴瘤(NHL)患者化疗前后外周血中免疫球蛋白及T细胞亚群、NK细胞、CD4+CD25+调节性T细胞的变化,探讨R-CHOP方案对B细胞NHL患者免疫系统的影响。方法:采用免疫速率比浊法和流式细胞术检测32例B细胞NHL患者(治疗组)化疗前后免疫球蛋白(IgG、IgA、IgM)及补体C3、C4的变化和T细胞亚群、NK细胞、CD4+CD25+调节性T细胞的分布特点,并与23例健康对照者(对照组)的相应指标进行比较。结果:①治疗组采用R-CHOP方案化疗后,IgG、IgA、IgM逐渐下降,其中IgM下降最明显,第1个疗程以后IgM与治疗前比较差异有统计学意义(P<0.05),而IgG、IgA于第2个疗程后才与治疗前比较差异有统计学意义(P<0.05)。②化疗后补体C3、C4含量升高,仅第4个疗程C3与治疗前比较差异有统计学意义(P<0.05);至第1个疗程后,C4与治疗前比较差异有统计学意义(P<0.05);随访3个月后,免疫球蛋白IgG、IgA、IgM和补体C3、C4含量基本恢复正常。③治疗组在治疗前IgG较对照组高,补体C3较对照组低,均差异有统计学意义(均P<0.05)。④治疗组采用R-CHOP方案化疗后,CD3、CD4、CD4/CD8、NK细胞比例显著下降,CD8、T调节细胞比例明显升高,2个疗程后,除NK细胞外,其余指标与治疗前比较均差异有统计学意义(均P<0.05)。6个疗程后,所有指标与治疗前比较均差异有统计学意义(均P<0.05)。⑤治疗组在治疗前CD3、CD4、CD4/CD8、NK细胞比对照组明显低,而CD8、T调节性细胞比对照组明显高,均差异有统计学意义(均P<0.05)。结论:B细胞性NHL患者细胞免疫功能受到明显抑制,体液免疫功能基本正常,R-CHOP方案化疗后,患者免疫球蛋白、NK细胞明显下降,T细胞亚群紊乱,机体的免疫功能受损。因此,化疗期间应该监测患者的免疫功能变化,及时调整用药及预防感染的发生。

Objective：To measure changes in immunoglobulin and T lymphocyte subsets,NK cell and CD4^＋CD25^＋regulatory T cell（Treg）in patients with B-cell non-Hodgkin lymphoma（NHL）before and after chemotherapy and investigate the side effect of R-CHOP regimen on immune system in patients with NHL.Method：The peripheral blood was collected from 32patients with B-NHL before and after chemotherapy and from 23healthy people.The level of immunoglobulin and complement component C3,C4was detected by immunoturbidimetry.The population of CD3^＋,CD4^＋,CD8^＋,CD16＋CD56＋and CD4＋CD25＋Foxp3＋was evaluated by flow cytometry.Result：①The level of immunoglobulin reduced gradually,especially the IgM reduced markedly after the first course of treatment（P〈0.05）,and the levels of IgG,IgA were much lower than those without chemotherapy from the second course of treatment（P〈0.05）.②The levels of complement component C3,C4were higher than those without chemotherapy.The levels of C4were higher than those without chemotherapy from the first course of treatment（P〈0.05）,while there was significant difference in C3compared with those without chemotherapy only at the fourth course of treatment（P〈0.05）.Three months after completing the chemotherapy,the levels of all of immunoglobulin and the levels of complement component C3,C4had recovered.③The content of IgG increased while C3decreased in the patients without chemotherapy compared with the controls（P〈0.05）.④The number of CD3^＋,CD4^＋,CD4^＋/CD8^＋ratio and NK cell reduced markedly after the treatment of R-CHOP regimen,with the exception of CD8^＋and CD4^＋CD25^＋Treg cell increased,there were significant difference in them compared with those without chemotherapy except NK cell at the second course of treatment.there were significant difference in them compared with those without chemotherapy after six cycles（P〈0.05）.⑤The number of CD3^＋,CD4^＋,CD4^＋/CD8^＋ratio and NK cell were much fewer than those in the controls,while the percentage of CD8＋and CD4＋CD25＋Treg cell were higher than those in the controls（P〈0.05）.Conclusion：The cellular immune function in patients with B-NHL was suppressed significantly,while the humoral immune function approximate normal.After the treatment of R-CHOP,the level of immunoglobulin and NK cells reduced markedly and T cell subsets were in disorder,which damage the immune system and the patients would become more susceptible to infection.Therefore,it is necessary to monitor the changes in the indicators of immune system to adjust the medication timely and prevent infection.