外周血中髓源性抑制细胞比例与非小细胞肺癌患者临床分期及免疫功能的关系

Relationship between the proportion of myeloid derived suppressor cells in peripheral blood of patients with non small cell lung cancer and its clinical stage and immune function

目的探讨外周血中髓源性抑制细胞（MDSCs）比例与非小细胞肺癌患者临床分期及免疫功能的关系。方法随机选取2013年4月至2015年3月间收治的非小细胞肺癌患者40例,另以同期健康体检者30例为对照组。非小细胞肺癌患者分为非小细胞肺癌Ⅰ-Ⅱ期组和非小细胞肺癌Ⅲ-Ⅳ期组。取非小细胞肺癌患者和健康体检者的外周血,采用流式细胞仪对MDSCs比例进行测定。对3组患者外周血中的MDSCs比例进行比较,对非小细胞肺癌Ⅲ-Ⅳ期组及健康对照组的体液免疫功能及细胞免疫功能进行评价比较。结果健康体检者及非小细胞肺癌Ⅰ-Ⅱ期组患者外周血中的MDSCs比例显著低于非小细胞肺癌Ⅲ-Ⅳ期组（均P〈0.001）,非小细胞肺癌Ⅰ-Ⅱ期组患者外周血中的MDSCs比例高于健康对照组,但差异无统计学意义（P=0.25）;非小细胞肺癌Ⅲ-Ⅳ期患者外周血中Ig A和Ig G水平高于健康体检者,但差异无统计学意义（P=0.06,P=0.07）;Ⅲ-Ⅳ期非小细胞肺癌患者Ig M水平显著低于健康体检者（P〈0.001）;Ⅲ-Ⅳ期非小细胞肺癌患者补体C3和补体C4水平均显著高于健康体检者（均P〈0.001）;在Ⅲ-Ⅳ期非小细胞肺癌患者和健康体检者前臂皮内注射0.1 ml结核菌素后,Ⅲ-Ⅳ期非小细胞肺癌患者阳性率显著低于健康体检者（P〈0.001）。结论随着病情进展与临床分期增大,非小细胞肺癌患者外周血中MDSCs比例越高,且非小细胞肺癌患者机体免疫功能下降。临床上,可将外周血中MDSCs比例作为非小细胞肺癌临床分期的参考指标之一。

Objective Toexplore relationship between myeloid-derived suppressor cells（ MDSCs）proportion in the peripheral blood of patients with non-small cell lung cancer（ NSCLC） and clinical staging and the immune function. Methods The 40 patients with NSCLC and 30 healthy physical examinees from April 2013 to March 2015 in Dalian Central Hospital were selected as research object. Healthy physical examinees were selected asthe control group,and patients with NSCLC were divided into NSCLCⅠ / Ⅱ phasegroupand NSCLCⅢ / Ⅳphasegroup. Peripheral blood of patients with NSCLC and healthy physical examinees was withdrawn and disposed for MDSCs proportion determination by flow cytometry. MDSCsproportionin the peripheral blood of patients in the three groups was compared,humoral immune function and cellular immune function of the control group and NSCLC Ⅲ / Ⅳ phasegroup were compared. Results MDSCsproportionof the control group and the NSCLCⅠ / Ⅱ phasegroup was statistically lower than that of NSCLCⅢ / Ⅳphasegroup（ t = 8. 45,7. 33; P〈0. 001）. MDSCs proportion of the NSCLCⅠ / Ⅱ phasegroup was higher than that of the control group,but there was no statistically significant difference（ t = 1. 15,P = 0. 25）. Ig A and Ig Gin the peripheral bloodof NSCLCⅢ / Ⅳ phasegroupwas higher than that ofthe control group,but there was no statistically significant difference（ t = 1. 95,1. 88; P = 0. 06,0. 07）; Ig M of NSCLC Ⅲ / Ⅳ phasegroupwasstatistically higher than that ofthe control group（ t = 4. 18,P〈0. 001）; Alexin C3 and C4 of NSCLC Ⅲ / Ⅳ phasegroup were statistically higher than that ofthe control group（ t = 3. 29,3. 65; P〈0. 001）; After intracutaneous injection of 0. 1 ml of tuberculin,positive rate of NSCLC Ⅲ / Ⅳ phasegroup was statisticallylower than that ofthe control group（ P〈0. 001）. Conclusions With the progress of the disease and the clinical stage increasing,the MDSCs proportion in the peripheral blood of patients with NSCLC is higher and the immune function is lower. Clinically,the MDSCs proportion in the peripheral blood can be used as one of staging reference for NSCLC.