光动力疗法联合CIK细胞治疗对中晚期食管癌患者免疫功能及临床预后的影响

Effect of photodynamic therapy combined with CIK cell therapy on immune function and clinical prognosis in patients with advanced esophageal cancer

目的探讨光动力疗法（PDT）联合CIK细胞治疗对中晚期食管癌患者免疫功能及临床预后的影响。方法将62例中晚期食管癌患者随机分为2组：A组32例行单纯PDT治疗,先给予光敏剂喜泊分注射液5 mg/kg静脉注射,于24 h后在胃镜引导下使用630nm波长的激光进行照射,功率密度150 m W/cm2,持续30 min,能量密度270 J/cm2。B组30例行PDT联合CIK治疗,CIK免疫细胞培养14 d,期间第12天给光敏剂药物,第13天进行胃镜引导下激光照射治疗,第14天回输免疫细胞,每次回输细胞〉1×109个,间隔1~2 d 1次,共3次。检测2组治疗前1周及治疗后第2周T淋巴细胞亚群水平,观察患者治疗期间及治疗后肝肾功能的变化以及治疗过程中出现的不良反应,统计2组患者治疗后发热、胸痛、咳嗽咳痰不良反应发生率,复查内镜并取组织病理检查治疗后3个月、6个月、12个月肿瘤原位复发情况。结果 A组治疗后CD3＋、CD3＋CD8＋均明显高于治疗前（P均〈0.05）,B组治疗后CD3＋、CD3＋CD8＋、CD3＋CD56＋均明显高于治疗前（P均〈0.05）;B组治疗后CD3＋、CD3＋CD56＋明显高于A组（P均〈0.05）,2组CD3＋CD8＋比较差异无统计学意义（P〉0.05）。B组发热、胸痛、咳嗽咳痰发生率明显低于A组（P均〈0.05）,12个月局部控制失败率明显低于A组（P〈0.05）。结论 PDT联合CIK细胞治疗模式具有协同效应,可提高患者机体整体免疫功能,改善肿瘤微环境,减少不良反应,降低肿瘤复发率,值得临床推广应用。

Objective It is to investigate the effect of photodynamic therapy（ PDT） combined with cytokine-induced killer（ CIK） cell therapy on immune function and prognosis in patients with advanced esophageal cancer. Methods 62 cases of advanced esophageal cancer patients were randomly divided into 2 groups,32 cases in group A were treated by PDT,photosensitive drug hematoporphyrin injection of 5 mg / kg were gave first for intravenous injection,630 nm laser irradiation were gave after 24-hour under the guidance of gastroscopy,then treated with power density of 150 m W / cm2,continued for 30 min,energy density of 270 J / cm2. 32 cases in group B were received PDT combined with CIK cell therapy,CIK immune cells cultured for14-day,photosensitizer drug were gave on the 12 th day,and gave gastroscope guided laser irradiation therapy on the 13 th day,and treated with transfusion immune cells on the 14 th day,each transfusion cell 1 × 109,the interval of 1 to 2 days for 1times,a total of three times. The levels of T lymphocyte subsets were observed in two groups were detected before and after treatment,the changes of liver and kidney function and the adverse reactions in treatment process were observed,the incidence of adverse reactions as fever,chest pain,cough expectoration were calculated in 2 groups,the recurrence of tumors in 3months,6 months and 12 months after the treatment was reviewed. Results After treatment,the levels of CD3＋,CD3＋CD8＋T cells were significantly higher in group A（ all P〈0. 05）,and the levels of CD3＋,CD3＋CD8＋and CD3＋CD56＋were increased significantly in group B（ all P〈0. 05）; the levels of CD3＋,CD3＋CD56＋in group B were markedly higher than that in group A（ all P〈0. 05）,while there was not statistically significant in the levels of CD3＋CD8＋between two groups（ P〈0. 05）. The incidence rates of fever,chest pain,cough expectoration and the 12-month local control rates in group B were significantly lower than that in group A（ all P〈0. 05）. Conclusion PDT combined with CIK cell therapy have synergistic effect on advanced esophageal cancer,which can improve the patient＇s overall immune function and the tumor microenvironment,reduce adverse reactions and tumor recurrence rate,it is worth clinical application.