“套餐式”微创手术治疗对原发性肝癌患者免疫功能及MMP-9、VEGF的影响

Effect of “package”minimally invasive surgery on immune function and MMP-9,VEGF in patients with primary liver cancer

目的探讨"套餐式"微创手术治疗原发性肝癌的疗效及对血清T淋巴细胞亚群(CD3^+、CD4^+、CD8^+、CD4^+/CD8^+比值)、NK细胞(CD56^+)、金属蛋白酶-9(MMP-9)和血管内皮生长因子(VEGF)的影响。方法选取原发性肝癌患者85例,根据患者治疗意愿分为3组:A组35例行单纯肝动脉化疗栓塞(TACE)治疗,B组30例行TACE^+氩氦刀冷冻治疗,C组20例行TACE^+氩氦刀冷冻^+125I放射性粒子植入治疗;观察3组治疗前后血清T淋巴细胞亚群、CD56^+、MMP-9和VEGF水平变化情况,统计3组术后近期肿块缩小率及随访12,16个月复发率和生存率。结果治疗2周后,3组血清CD3^+、CD4^+、CD4^+/CD8^+比值、NK细胞水平均明显升高(P均<0.05),CD8^+和MMP-9、VEGF水平均明显降低(P均<0.05);治疗5周和7周后,B组和C组各指标改善情况均明显优于治疗2周后和A组(P均<0.05);术后7周,C组各指标改善情况均明显优于术后5周及B组(P均<0.05)。术后12周,B组和C组肿块缩小率明显高于A组(P<0.05),C组明显高于B组(P<0.05)。随访12,16个月,B组和C组复发率均明显低于A组,生存率均明显高于A组,且C组复发率明显低于B组,生存率明显高于B组,差异均有统计学意义(P均<0.05)。结论 "套餐式"微创治疗原发性肝癌效果更好,可明显改善机体免疫功能,抑制肿瘤血管的新生,降低复发率和病死率,值得临床推广应用。

Objective It is to investigate the curative effect of＂package＂minimally invasive surgery in primary liver cancer,and observe its influence on the serum T lymphocyte subsets（ CD3~＋,CD4~＋,CD8~＋,CD4~＋/ CD8~＋ratio） and NK cells（ CD56~＋）,matrix metalloproteinase 9（ MMP- 9） and vascular endothelial growth factor（ VEGF）. Methods 85 patients with primary liver cancer were selected and divided into 3 groups according to the wishes of the patients： 35 cases in group A were treated with transcatheter arterial chemoembolization（ TACE）,30 cases in group B were treated with TACE ~＋ argon helium knife,20 cases in group C were treated with TACE ~＋ argon helium knife frozen ~＋125I radioactive seed implantation; the changes of serum T lymphocyte subsets,CD56~＋,MMP- 9 and VEGF levels were observed before and after treatment,and the postoperative tumor shrinkage rate and recurrence rate and survival rate follow-up 16,12 months were recorded in 3 groups.Results After 2 weeks of treatment,the serum levels of CD3~＋,CD4~＋,CD4~＋/ CD8~＋and NK were significantly increased,and the levels of CD8~＋,MMP- 9 and VEGF were significantly reduced in the 3 groups（ all P 〈0. 05）. After 5 weeks and 7weeks treatment,the indexes of group B and C were significantly better than those after 2 weeks and those of group A in the same time（ all P 〈0. 05）; at 7 weeks after operation,the improvement of the indexes of group C was significantly better than those at 5 weeks and those of group B in the same time（ all P 〈0. 05）; at 12 weeks after operation,the tumor shrinkage rate of group B and C were significantly higher than that of group A（ P 〈0. 05）,and group C was significantly higher than that of group B（ P 〈0. 05）. The recurrence rate in group B and C was significantly lower,and the survival rates were significantly higher than that in the group A at 16 months follow-up（ all P 〈0. 05）; and the recurrence rate of group C was significantly lower,survival rate was significantly higher than that of group B（ all P 〈0. 05）. Conclusion The curative effect of＂package＂minimally invasive surgery in primary liver cancer is better,it can obviously improve the immune function of the body,inhibit tumor angiogenesis,reduce the recurrence rate and mortality,it is worthy of clinical popularization and application.