弥漫大B细胞淋巴瘤患者化疗前后免疫功能变化的临床意义

Clinical significance of immune function changes in patients with diffuse large B-cell lymphoma before and after chemotherapy

目的探讨弥漫大B细胞淋巴瘤(DLBCL)患者化疗前后免疫功能水平变化情况。方法选择60例初治DLBCL患者为研究组,另选择60名同期健康体检者为对照组,采用流式细胞仪检测研究组及对照组的T淋巴细胞亚群、B淋巴细胞群、NK细胞的水平,对比分析两组化疗前后上述各指标的临床意义。结果(1)研究组化疗前T淋巴细胞亚群中CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)及NK细胞水平明显低于对照组,CD8^(+)水平高于对照组,差异有统计学意义(P<0.05),而化疗后CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)及NK细胞水平较化疗前明显改善(P<0.05)。(2)化疗前,化疗有效组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)及NK细胞水平明显高于化疗无效组,CD8^(+)水平低于对照组,差异有统计学意义(P<0.05);化疗后,化疗有效者T淋巴细胞亚群及NK细胞水平较化疗前明显改善(P<0.05),但仍低于对照组(P<0.05)。(3)无效组化疗前和化疗后相比T淋巴细胞亚群及NK细胞水平均无统计学意义(P>0.05);研究组化疗前、化疗后CD19^(+)水平与对照组相比均无统计学意义(P>0.05)。结论DLBCL患者体内存在免疫抑制,以细胞免疫抑制为主,与体液免疫关系不确切。动态监测T淋巴细胞亚群及NK细胞水平可作为DLBCL患者免疫功能监测、监测病情及判断预后的指标之一。

Objective To investigate the immune function changes of patients with diffuse large B-cell lymphoma(DLBCL)before and after chemotherapy.Methods 60 patients with newly diagnosed DLBCL were selected as study group,and 60 healthy subjects at the same period were selected as control group.The levels of T lymphocyte subsets,B lymphocyte subsets and NK cells in the study group and the control group were detected by flow cytometry,and the clinical significance of these indexes before and after chemotherapy was comparatively analyzed.Results(1)The levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+),and NK cells in T lymphocyte subsets in the study group before chemotherapy were significantly lower than those in the control group,and the level of CD8^(+)was higher than that in the control group,and differences were statistically significant(P<0.05).And the levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+),and NK cells after chemotherapy were improved significantly while comparing with those before chemotherapy(P<0.05).(2)The levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+),and NK cells before chemotherapy in the chemotherapy-effective group were significantly higher than those in the chemotherapy-ineffective group,the level of CD8^(+)was lower than that in the control group,and the differences were statistically significant(P<0.05).After chemotherapy,the levels of T lymphocyte subsets and NK cells in patients with effective chemotherapy were significantly improved compared with those before chemotherapy(P<0.05),but still lower than those in the control group(P<0.05).(3)There was no statistically significant difference in T lymphocyte subsets and NK cell levels before and after chemotherapy in the ineffective group(P>0.05);in the study group,there was no statistically significant difference in CD19^(+)levels between study group and control group before and after chemotherapy(P>0.05).Conclusion There is immunosuppression in patients with DLBCL,mainly cellular immunosuppression,and its relationship with humoral immunity is not clear.Dynamic monitoring of T lymphocyte subsets and NK cell levels can be used as one of the indicators of immune function monitoring,disease monitoring,and prognosis in patients with DLBCL.