术前胸腺肽α_1新辅助化疗对老年食管癌患者术后免疫功能的影响

Effect of neoadjuvant chemotherapy on immune function in elderly patients with esophageal cancer after surgical treatment

目的:探讨术前胸腺肽α_1新辅助化疗对老年食管癌患者术后免疫功能的影响。方法:选取Ⅱ、Ⅲ期老年食管癌患者46例为研究对象,随机分为对照组与治疗组组,各23例,所有患者术前均进行常规DP(多西他赛+奈达帕)方案化疗,治疗组采用DP结合胸腺肽α_1新辅助化疗方案,而对照组只采用常规DP方案化疗,分别于化疗前1天、化疗1周期、2周期后及手术后7 d抽取患者外周血,采用流式细胞技术检测NK细胞含量变化及T细胞亚群(CD4+、CD8+、CD4+/CD8+、CD3+)的百分率。结果:化疗1周期、2周期及术后7 d,治疗组CD3+、CD4+、CD8+、CD4+/CD8+水平显著高于对照组,差异有统计学意义(P<0.05),且2周期化疗和术后7 d后,治疗组NK细胞含量显著高于对照组,差异有统计学意义(P<0.05),治疗组CD3+、CD4+、CD8+、CD4+/CD8+水平较前增加幅度显著;在粒细胞减少上,治疗组更显著低于对照组,差异有统计学意义(P=0.001),治疗组化疗不良反应显著低于对照组,差异有统计学意义(P<0.05);治疗组肺部感染发生率显著低于对照组,差异有统计学意义(P<0.05);在术后并发症方面,两组总发生率差异无统计学意义(P=0.356)。结论:胸腺肽α_1新辅助化疗应用于Ⅱ、Ⅲ期老年食管癌术后,可有效提高患者对化疗及手术的耐受性,增强患者免疫功能,不良反应小,有利于改善患者生活质量。

Objective To investigate the effect of neoadjuvant chemotherapy in elderly patients with esophageal cancer after operation. Method Forty-six patients with esophageal cancer were selected and randomly divided into two groups（n = 23） and control group（n = 23）. The control group was treated with surgery. Post-neoadjuvant chemotherapy. The peripheral blood of the patients was taken 1 week before chemotherapy,1 week after chemotherapy,2 cycles and 7 days after operation. Flow cytometry（FCM） was used to detect the changes of NK cells. The expression of T cell subsets（CD4＋,CD8＋,CD4＋/CD8＋,CD3＋）. Results The levels of CD3＋,CD4＋,CD8＋,CD4＋/CD8＋in the treatment group were significantly higher than those in the control group（P〈0. 05）,and 2 cycles of chemotherapy and chemotherapy the levels of CD3＋,CD4＋,CD8＋,CD4＋/CD8＋in the treatment group were significantly higher than those in the control group（P〈0. 05）. After 7 days,the levels of NK cells in the treatment group were significantly higher than those in the control group（P〈0. 05）. In the case of granulocytic reduction,the treatment group was significantly lower than that in the control group（P = 0. 01）. The incidence of pulmonary infection in the treatment group was significantly lower than that in the control group（P〈0. 05） The overall incidence of postoperative complications was not statistically significant（P = 0. 356）. Conclusion Neoadjuvant chemotherapy is applied to the patients with esophageal cancer in stage Ⅱ and Ⅲ,which can improve the patient＇s immune function and improve the immune function,and the adverse reaction is small,which is helpful to improve the quality of life of patients.