不同级别脑胶质瘤患者围术期细胞免疫水平变化及其与术后颅内感染关系的研究

Cellular immune level changes of patients with different grades of glioma in perioperative period and its relationship with postoperative intracranial infection

目的检测不同级别脑胶质瘤患者手术前后细胞免疫水平变化,探讨其与术后颅内感染的关联性。方法收集山西医科大学第一医院2017年9月至2018年9月收治的行手术治疗、经病理确诊的脑胶质瘤初发患者53例,按照世界卫生组织(WHO)分级标准分为低级别组(Ⅰ~Ⅱ级)21例,高级别组(Ⅲ~Ⅳ级)32例。抽取患者术前1 d、术后1 d、术后7 d外周血,检测T淋巴细胞亚群水平,分析不同级别患者细胞免疫指标差异;分析免疫水平与术后颅内感染的关系。采用SPSS 22.0统计学软件分析数据。结果高级别组患者术前1 d CD3^+、CD4^+、CD8^+、CD4^+ CD25^+ Foxp3^+水平及CD4^+/CD8^+分别为(54.09±4.25)%、(31.93±3.08)%、(34.23±2.48)%、(9.66±1.47)%、0.93±0.06,术后1 d分别为(48.84±3.69)%、(27.49±2.41)%、(34.99±2.96)%、(11.09±1.70)%、0.84±0.05,术后7 d分别为(59.45±3.47)%、(33.59±2.66)%、(31.99±1.97)%、(7.45±1.48)%、1.05±0.07。低级别组术前1 d CD3^+、CD4^+、CD8^+、CD4^+ CD25^+ Foxp3^+水平及CD4^+/CD8^+分别为(62.37±6.57)%、(34.88±4.43)%、(30.16±3.75)%、(6.30±1.29)%、1.16±0.11,术后1 d分别为(55.44±7.25)%、(29.05±4.04)%、(31.66±3.13)%、(7.95±1.67)%、0.92±0.11,术后7 d分别为(67.73±7.18)%、(35.55±4.95)%、(28.10±3.12)%、(5.50±1.25)%、1.27±0.12。高级别组手术前后CD3^+、CD4^+水平及CD4^+/CD8^+均低于低级别组(均P<0.05),CD8^+、CD4^+ CD25^+ Foxp3^+水平均高于低级别组(均P<0.05);与术前1d相比,术后1 d两组患者CD3^+、CD4^+水平及CD4^+/CD8^+均降低(均P<0.05),CD8^+、CD4^+ CD25^+ Foxp3^+水平均升高(均P<0.05),术后7 d两组患者CD3^+、CD4^+水平及CD4^+/CD8^+均增高(均P<0.05),CD8^+、CD4^+ CD25^+ Foxp3^+水平均降低(均P<0.05)。53例患者中,8例发生术后颅内感染,感染率为15.09%;年龄、手术时间、病理分期、术中是否输血是脑胶质瘤术后颅内感染的独立影响因素(OR=1.513,P=0.024;OR=1.722,P<0.01;OR=1.365,P=0.001;OR=1.262,P<0.01)。结论脑胶质瘤患者外周血细胞免疫功能水平与胶质瘤恶性程度相关;手术切除胶质瘤体可减轻细胞免疫受抑制程度。T淋巴细胞亚群测定或可作为胶质瘤患者恶性程度及预后的评价指标之一。临床免疫细胞检测或对胶质瘤患者术后颅内感染的预测、预防有积极意义。

Objective To detect the changes of cellular immune level in patients with different grades of glioma in perioperative period, and to investigate its relationship with the postoperative intracranial infection. Methods A total of 53 patients with glioma newly diagnosed by pathology who underwent the surgical treatment in the First Hospital of Shanxi Medical University from September 2017 to September 2018 were collected. According to the World Health Organization (WHO) classification criteria, the patients were divided into the low-grade group (grade Ⅰ-Ⅱ, 21 cases) and the high-grade group (grade Ⅲ-Ⅳ, 32 cases). The peripheral blood at the time of 1 day before the operation, 1 day and 7 days after the operation was drawn to detect the T lymphocyte subsets, and then the differences of cell immunity indexes from different grade gliomas were analyzed. The relationship between immune level and postoperative intracranial infection was analyzed. SPSS 22.0 statistical software was used to analyze the data. Results The levels of CD3^+, CD4^+, CD8^+, CD4^+ CD25^+ Foxp3^+ and CD4^+/CD8^+ in the high-grade group at the time of 1 day before the operation were (54.09±4.25)%,(31.93±3.08)%,(34.23±2.48)%,(9.66±1.47)%, 0.93±0.06, respectively;the levels at the time of 1 day after the operation were (48.84±3.69)%,(27.49±2.41)%,(34.99±2.96)%,(11.09±1.70)%, 0.84±0.05, respectively;the levels at the time of 7 days after the operation were (59.45±3.47)%,(33.59±2.66)%,(31.99±1.97)%,(7.45±1.48)%, 1.05±0.07, respectively. The levels of CD3^+, CD4^+, CD8^+, CD4^+ CD25^+ Foxp3^+ and CD4^+/CD8^+ in the low-grade group at the time of 1 day before the operation were (62.37±6.57)%,(34.88±4.43)%,(30.16±3.75)%,(6.30±1.29)%, 1.16±0.11, respectively;the levels at the time of 1 day after the operation were (55.44±7.25)%,(29.05±4.04)%,(31.66±3.13)%,(7.95±1.67)%, 0.92±0.11, respectively;the levels at the time of 7 days after the operation were (67.73±7.18)%,(35.55±4.95)%,(28.10±3.12)%,(5.50±1.25)%, 1.27±0.12, respectively. The levels of CD3^+, CD4^+, CD4^+/CD8^+ before and after the operation in the high-grade group were lower than those in the low-grade group (all P < 0.05), while the levels of CD8+ and CD4^+ CD25^+ Foxp3^+ were higher than those in the low-grade group (all P < 0.05). Compared with the levels at the time of 1 day before the operation, the levels of CD3^+, CD4^+, CD4^+/CD8^+ at the time of 1 day after the operation of both groups were decreased, while the levels of CD8^+ and CD4^+ CD25^+ Foxp3^+ were increased (all P < 0.05). The levels of CD3^+, CD4^+ and CD4^+/CD8^+ at the time of 7 days after the operation in the both groups were increased, while the levels of CD8^+ and CD4^+ CD25^+ Foxp3^+ were decreased (all P < 0.05). Among 53 patients, 8 cases had postoperative intracranial infection, and the infection rate was 15.09%. Age, duration of surgery, pathological stage, and intraoperative blood transfusion were the independent affecting factors of postoperative intracranial infection of cerebral glioma (OR=1.513, P=0.024;OR=1.722, P < 0.01;OR=1.365, P=0.001;OR=1.262, P < 0.01). Conclusions The peripheral blood cellular immune level of glioma patients is related with the malignancy of glioma. The inhibition degree of the cellular immunity could be relieved after the resection of glioma. The detection of T lymphocyte subsets could be considered as an evaluating index for the malignancy and prognosis in patients with glioma. The clinical detection of cellular immune can play a positive role in predicting and preventing the postoperative intracranial infection in patients with glioma.