食管癌胸腔镜根治术患者术后抑郁对其外周血T调节细胞和预后的影响

Effect of Depression on Peripheral Blood T Regulatory Cells and the Prognosis of Patients with Esophageal Carcinoma After Thoracoscopic Radical Resection

目的：分析食管癌胸腔镜根治术患者术后抑郁对其外周血T调节细胞及预后的影响。方法：选择2012年5月-2014年4月于我院接受胸腔镜根治术治疗的106例食管癌患者作为研究对象,术后均采用抑郁自评量表（SDS）评定其抑郁程度,并按有无抑郁分为抑郁组与非抑郁组,比较两组外周血T调节细胞水平及预后的差异,分析术后抑郁与预后的关系。结果：本组106例患者中55例（51.89%）术后发生抑郁,抑郁组女性、〈60岁、肿瘤直径〉5cm、肿瘤低分化程度、合并淋巴结转移、TNM分期为Ⅲ期所占比例均高于非抑郁组（χ^2=9.192,9.265,8.442,10.357,13.087,4.261;P〈0.05）,且其外周血CD4＋CD25＋、CD8＋水平高于非抑郁组,CD4＋、CD4＋/CD8＋水平低于非抑郁组（t=7.087,3.294,8.822;P〈0.05）;女性、肿瘤分化程度、淋巴结转移、临床分期、CD4＋CD25＋与食管癌根治术后抑郁呈正相关（r=0.435,0.416,0.474,0.422,0.454;P〈0.05）,年龄、CD4＋、CD4＋/CD8＋呈负相关（r=-0.385,-0.426;P〈0.05）;抑郁组术后3年生存率高于非抑郁组（χ^2=10.853,P〈0.05）;食管癌胸腹腔镜根治术术后抑郁与患者术后生存率呈负相关（r=-0.374,P〈0.05）。结论：食管癌胸腔镜根治术患者术后抑郁与性别、年龄、肿瘤分化程度、淋巴结转移、临床分期、T调节细胞水平均有关,同时对患者预后产生影响,推测其主要通过影响机体免疫调节,下调外周T调节细胞水平,造成免疫紊乱,导致肿瘤复发、转移,影响其生存率。

Objective：To analyze the effect of depression on peripheral blood T regulatory cells and the prognosis of patients with esophageal carcinoma after thoracoscopic radical resection.Methods：A total of 106 patients with esophageal carcinoma who were treated by thoracoscopic radical resection in our hospital from May 2012 to April 2014 were enrolled in the study.The degree of depression was assessed by the self rating Depression Scale（SDS）,and the patients were divided into the depression group and the non-depression group according to whether patients had depression.Levels of T regulatory cells and the prognosis were compared between the two groups,and the relation between postoperative depression and the prognosis was analyzed.Results：Of the 106 patients,there were 55 patients（51.89%）with depression after operation.The proportions of female patients,patients who were younger than 60 years old,patients whose tumor diameter was longer than 5 cm,patients with low degree of tumor differentiation,patients with lymph node metastasis and patients whose TNM stage was III in the depression group were higher than those in the non-depression group（χ^2=9.192,9.265,8.442,10.357,13.087,4.261,all P〈0.05）.Levels of CD4＋CD25＋ and CD8＋ in peripheral blood of the depression group were higher than those in the non-depression group,while levels of CD4＋ and CD4＋/CD8＋ were lower than those in the non-depression group（t=7.087,3.294,8.822,all P〈0.05）.The female sex,the degree of tumor differentiation,lymph node metastasis,clinical stage and CD4＋CD25＋ were positively correlated with depression of patients with esophageal carcinoma after radical resection（r=0.435,0.416,0.474,0.422,0.454,P〈0.05）,while age,CD4＋ and CD4＋/CD8＋ were negatively correlated with depression（r=-0.385,-0.426,P〈0.05）.The 3-year survival rate of the depression group was higher than that of the non-depression group（χ^2=10.853,P〈0.05）.The depression of patients with esophageal carcinoma after radical resection was negatively correlated with the postoperative survival rate（r=-0.374,P〈0.05）.Conclusion：Depression of patients with esophageal carcinoma after thoracoscopic radical resection is related to gender,age,the degree of tumor differentiation,lymph node metastasis,clinical stage and levels of T regulatory cells,and it can affect the prognosis of patients.It may cause immune disorder,tumor recurrence and metastasis and affect patients＇ survival rate by influencing the immune regulation and down-regulation of peripheral T regulatory cells.