冷循环射频消融术治疗原发性肝癌患者疗效及外周血Treg细胞的变化观察

Short-term efficacy of radiofrequency ablation with cold circulation in the treatment of patients with primary liver cancer

目的探讨采用冷循环射频消融术治疗原发性肝癌(PLC)患者的疗效及对外周血调节性T细胞(Treg)的影响。方法2018年4月~2019年4月我院收治的PLC患者94例,随机分为射频消融治疗组47例和经肝动脉化疗栓塞术(TACE)治疗47例,分别使用TM-RFTI1型冷循环射频消融系统行视频消融或采用碘化油与表柔比星混悬乳液或明胶海绵化疗栓塞。使用FACSCalibur流式细胞仪检测外周血调节性T细胞(Treg)百分比。结果在治疗后3个月评估,射频消融治疗组完全缓解、部分缓解和疾病稳定发生率分别为42.6%、40.4%和6.4%,疾病控制率为89.4%,显著高于TACE治疗组【分别为31.9%、27.7%、12.8%和72.3%,P<0.05】;治疗前,射频消融治疗组血清ALT、ALP、TBIL和外周血Treg细胞百分比分别为(96.4±22.4)U/L、(184.5±30.5)U/L、(18.5±5.8)μmol/L和(9.5±1.5)%,与TACE组比,无统计学差异[分别为(94.6±25.2)U/L、(184.8±30.6)U/L、(17.6±4.9)μmol/L和(9.5±1.6)%,P>0.05],治疗后,射频消融治疗组血清ALT和ALP及外周血Treg细胞百分比分别为(35.1±5.8)U/L、(84.5±15.8)U/L和(6.2±0.5)%,显著低于TACE治疗组[分别为(40.2±8.5)U/L、(108.5±24.8)U/L和(8.1±0.9)%,P<0.05];射频消融术后腹胀、腹泻、腹腔感染、发热和消化道出血等并发症发生率为8.5%,显著低于TACE治疗的25.5%,差异有统计学意义(P<0.05)。结论在彩超引导下采用冷循环射频消融治疗PLC患者可提高短期临床治疗效果,降低Treg细胞百分比,对肝功能的影响比较小,值得进一步临床研究。

Objective The aim of this study was to investigate the short-term efficacy of radiofrequency ablation(RFA)with cold circulation in the treatment of patients with primary liver cancer(PLC)and the change of peripheral blood fegulatory T cells(Treg).Methods A total of 94 patients with PLC were admitted to our hospital between April 2018 and April 2019,and were randomly divided into observation group(n=47)and control group(n=47).The patients in the control group received hepatic artery chemoembolization(TACE),while those in the observation group received RFA with cold circulation under the guidance of color ultrasound.The percentages of peripheral blood Treg cells were detected by TCM.Results At the end of three month after operation,the complete response,partial response and disease stable rates in the RFA-treated patients were 42.6%,40.4%and 6.4%,and the disease control rate was 89.4%,all significantly higher than(31.9%,27.7%,12.8%,and 72.3%,P<0.05)in TACE-treated patients except for disease stable rate;at presentation,serum ALT,ALP,total bilirubin and the percentage of peripheral blood cells in RFA-treated patients were(96.4±22.4)U/L,(184.5±30.5)U/L,(18.5±5.8)μmol/L and (9.5±1.5)%,not significantly different compared to[(94.6±25.2)U/L,(184.8±30.6)U/L,(17.6±4.9)μmol/L and(9.5±1.6)%,respectively,P>0.05]in TACE-treated patients,while serum ALT,ALP and percentage of peripheral blood Treg cells in RFA-treated patients were(35.1±5.8)U/L,(84.5±15.8)U/L and(6.2±0.5)%after operation,all significantly lower than[(40.2±8.5)U/L,(108.5±24.8)U/L and(8.1±0.9)%,respectively,P<0.05]in TACE-treated patients;the incidence of post operation complications such as abdominal distension,diarrhea,peritonitis,fever and gastrointestinal bleeding was 8.5%,significantly lower than 25.5%(P<0.05)in TACE-treated group.Conclusion The application of RFA with cold circulation under color ultrasound guidance in treatment of patients with PLC could get excellent short-term efficacy,which might reduce peripheral blood Treg cells,and has a higher safety.