进展期胃癌患者化疗前后免疫调节因子及肿瘤标志物的动态研究

Dynamic study of immunoregulatory factors and tumor markers in patients with advanced gastric cancer before and after chemotherapy

目的分析进展期胃癌(advanced gastric cancer,AGC)患者化疗前后免疫调节因子及肿瘤标志物的动态变化.方法回顾性分析2017年3月至2018年12月广西科技大学第二附属医院化疗科58例进展期胃癌患者(胃癌组),根据化疗疗效分为有效组、稳定组、无效组,同时选取同期健康者30名为正常组.比较研究对象的免疫球蛋白(IgA、IgG、IgM)、T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)以及相关肿瘤标志物(CEA、CA199、CA242)化疗前后的变化情况.结果胃癌组患者IgA[(2.11±0.89)g/L]、IgM[(10.65±4.61)g/L]、IgG[(1.25±0.45)g/L]、CD8+[(28.12±3.56)%]、CEA[(40.33±16.24)μg/L]、CA199[(76.34±21.56) kU/L]、CA242[(29.34±9.57) kU/L]水平明显高于正常组IgA[(0.93±0.36)g/L]、IgM[(6.46±3.59)g/L]、IgG[(0.65±0.32)g/L]、CD8+[(25.02±4.78)%]、CEA [(1.81±0.55)μg/L]、 CA199 [(7.51±2.67)kU/L]、 CA242 [(3.35±1.21)kU/L](t 值分别为 6.958、3.600、6.495、3.435、12.952、17.370、14.773,P<0.05),而 CD3+[(64.12±5.12)%]、CD4+[(34.12±4.10)%]、CD4+/CD8+(1.09±0.28)低于正常组 CD3+[(71.23±7.14)%]、CD4+[(39.78±5.20)%]、 CD4+/CD8+(1.47±0.40)(t 值分别为 5.376、5.592、5.192,P<0.05).胃癌组患者总有效率为79.31%(46/58),无效率为20.69%(12/58).有效组患者经两个疗程化疗后的IgA、IgG、IgM、CD8+明显低于化疗前(t值分别为3.925、3.745、4.036、2.661,P均<0.05),而CD3+、CD4+、CD4+/CD8+明显高于化疗前(t值分别为3.520、3.077、3.218,P均<0.05),同时免疫球蛋白、T淋巴细胞亚细胞水平明显优于稳定组、无效组(P<0.05);有效组、稳定组患者经两个疗程化疗后的肿瘤标志物 CEA、CA199、CA242 水平明显低于化疗前(P<0.05),且明显低于无效组(P<0.05).结论 AGC患者在化疗后的免疫球蛋白、T淋巴细胞亚群以及肿瘤标志物水平有明显的变化,其水平高低可以指导化疗疗效.

Objective To analyze the dynamic changes of immunoregulatory factors and tumor markers before and after chemotherapy in patients with advanced gastric cancer. Methods From October 2015 to February 2018, 58 patients with chemotherapy AGC in our hospital were selected as gastric cancer group.According to the efficacy of chemotherapy they were divided into effective group, stable group and ineffective group.Meanwhile, 30 healthy persons were selected as normal group.The immunoglobulins (IgA, IgG, IgM), T lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+) and related tumor markers (CEA, CA199, CA242) were compared before and after chemotherapy. Results The levels of IgA((2.11±0.89)g/L), IgM((10.65±4.61)g/L), IgG((1.25±0.45)g/L), CD8+((28.12±3.56)%), CEA((40.33±16.24)μg/L), CA199((76.34±21.56) kU/L) and CA242((29.34±9.57)k U/L) in the gastric cancer group were significantly higher than those in the normal group IgA((0.93±0.36)g/L), IgM((6.46±3.59)g/L), IgG((0.65±0.32)g/L), CD8+((25.02±4.78)%), CEA((1.81±0.55)μg/L), CA199((7.51±2.67) kU/L), CA242((3.35±1.21) kU/L)(t=6.958, 3.600, 6.495, 3.435, 12.952, 17.370, 14.773, P<0.05), while CD3+((64.12±5.12)%), CD4+((34.12±4.10)%), CD4+/CD8+(1.09±0.28) were lower than the normal group (CD3+(71.23±7.14)%, CD4+(39.78±5.20)%, CD4+/CD8+(1.47±0.40))(t=5.376, 5.592, 5.192, P<0.05). The total effective rate of AGC patients in gastric cancer group was 79.31 %(46/58), and the ineffective rate was 20.69 %(12/58). IgA, IgG, IgM, and CD8+ in the effective group were significantly lower than those before chemotherapy (t=3.925, 3.745, 4.036, 2.661, P<0.05), while CD3+, CD4+, CD4+/CD8+ were significantly higher than before chemotherapy (t=3.520, 3.077, 3.218, P<0.05). The subcellular level of protein and T lymphocytes was significantly better than that of stable group and ineffective group (P<0.05). The levels of tumor markers CEA, CA199 and CA242 in the effective group and stable group were significantly lower than those before chemotherapy (P<0.05), and significantly lower than the ineffective group (P<0.05). Conclusion The levels of immunoglobulins, T lymphocyte subsets and tumor markers in patients with AGC have significant changes after chemotherapy, and their levels can guide the efficacy of chemotherapy.