肺癌患者调节性T细胞的变化及预测价值

The variation of circulating regulatory T cells count of lung carcinoma and its prognostic value for evaluating treatment response

目的探讨外周血CD4^＋CD25^＋CD127^low/－调节性T细胞（Treg）计数、肺癌标志物（TM）水平及相关临床病理特征预测非小细胞肺癌（NSCLC）治疗疗效的研究。方法采用流式细胞术检测Treg计数，酶联免疫吸附试验（ELISA）测定肺癌TM浓度；结合资料分析Treg计数、TM水平及相关临床病理特征对NSCLC患者治疗疗效的预测作用。结果NSCLC患者Treg计数明显高于健康对照组[（7.02±2.31）%比（4.53±0.86）%，t=6.949, P=0.000]。在肺癌中，Treg含量与分化程度（F=15.229，P=0.000）、肿块大小（t=－2.972，P=0.003）、TNM分期（t=－4.856，P=0.001）、有无脉管癌栓（t=－0.653，P=0.000）等有关。临床治疗有效组的Treg计数及血清TM水平低于临床治疗无效组，差异有统计学意义[Treg：（5.77±1.71）%比（7.02±2.02）%，t=－3.983，P=0.001；非小细胞肺癌相关抗原21-1（CYFRA21-1）： 2.88（2.13～4.44）比4.76（2.82～8.95），t=4.032，P=0.000；癌胚抗原（CEA）：2.72（1.54～4.01）比3.53（1.99～8.42）, t=2.385，P=0.017；糖类抗原125（CA125）：9.90（6.50～14.70）比19.20（11.50～57.25）, t=5.148，P=0.000]。采用Logistic回归对肺癌患者的治疗疗效进行分析，发现仅治疗前外周血Treg细胞和TNM分期为其独立的预测因子[Treg：比值比（OR）=3.993，P=0.001；TNM：OR=1.742，P=0.000]。结论Treg计数与NSCLC严重程度密切相关，治疗前外周血Treg计数和TNM分期可用于NSCLC综合治疗疗效的预测。

Objective To investigate the prognostic value of CD4^＋ CD25^＋ CD127^low/- regulatory T cells （Treg） in peripheral blood samples, tumor markers for lung cancer （TM） and associated clinicopathologic features for evaluating pre-treatment predictors of non-small cell lung cancer （NSCLC）.Methods The percentages of Treg were measured by flow cytometry, the level of serum TM was analyzed by enzyme linked immunosorbent assay （ELISA）; and then Treg cells, serum TM level and associated clinicopathologic features were used to evaluate the predictive value of NSCLC treatment.Results The percentages of Treg cells in patients with NSCLC were significantly higher than those in healthy control [（7.02±2.31）% vs. （4.53±0.86）%, t=6.949, P=0.000]. In the areas of lung cancer, a significant positive correlation was found among the percentages of Treg cells and degree of differentiation （F=15.229, P=0.000）, tumor size （t=-2.972, P=0.003）, TNM stage （t=-4.856, P=0.001）, vascular tumor thrombus （t=-0.653, P=0.000）. The baseline circulating Treg count and the serum TM level before treatment in NSCLC were lower in the patient group with positive treatment response than in the group with negative response [Treg： （5.77±1.71）% vs. （7.02±2.02）%, t=-3.983, P=0.001; cytokeratin 19 fragment （CYFRA21-1）： 2.88 （2.13-4.44） vs. 4.76 （2.82-8.95）, t=4.032, P=0.000; carcinoembryonic antigen （CEA）： 2.72 （1.54-4.01） vs. 3.53 （1.99-8.42）, t=2.385, P=0.017; carbohydrate antigen （CA）125： 9.90 （6.50-14.70） vs. 19.20 （11.50-57.25）, t=5.148, P=0.000]. Through logistic regression analysis, it revealed that pre-treatment Treg count and TNM stage were independent prognostic factors for clinical response to NSCLC treatment [odds ratio （OR）=3.993, P=0.001; OR=1.742, P=0.000].Conclusion The percentage of Treg cells was closely related to the severity of NSCLC development, and pre-treatment Treg count and TNM stage were a feasible method to predict clinical response to NSCLC treatment.