宫颈鳞状上皮内病变及早期宫颈癌患者外周血及阴道灌洗液中T细胞亚群变化的分析

Analysis on the changes of peripheral blood and vaginal lavage fluid T cell subsets in patients with squamous intraepithelial lesion and early cervical cancer

目的:探讨宫颈鳞状上皮内病变(SIL)及早期宫颈癌患者外周血及阴道灌洗液中T细胞亚群变化与病变发生发展的关系。方法:选取2015年1月至2016年12月在广西医科大学附属肿瘤医院妇瘤科、广西区妇幼保健院及广西医科大学第四附属医院就诊的高危型人乳头状瘤病毒(HR-HPV)阳性患者136例,根据病理结果分为低度鳞状上皮内病变(LSIL)组(n=20)、高度鳞状上皮内病变(HSIL)组(n=56)及早期宫颈癌组(n=60),同时,以HR-HPV阴性且宫颈活检正常者25例为阴性对照组。检测各组外周血及阴道灌洗液中CD3^+、CD4^+、CD8^+水平,计算CD4^+/CD8^+比值。结果:与对照组比较,LSIL组、HSIL组及早期宫颈癌组外周血中CD3^+、CD4^+水平明显降低,且随着宫颈病变程度的加重而降低(均P<0.05),4组间CD8^+水平和CD4^+/CD8^+比值比较,差异无统计学意义(P>0.05)。与对照组比较,LSIL组、HSIL组及早期宫颈癌组阴道灌洗液中CD4^+水平、CD4^+/CD8^+比值均降低(均P<0.05),而4组CD8^+水平比较,差异无统计意义(P>0.05)。结论:外周血及阴道灌洗液中T细胞亚群的检测对于SIL及宫颈癌的病情监测、宫颈癌的免疫治疗等具有重要指导意义。

Objective:To investigate the relationship between the changes of peripheral blood and vaginal lavage fluid T cell subsets and the development of squamous intraepithelial lesion(SIL)and early cervical cancer.Methods:From January 2015 to December 2016,136 patients with high-risk human papillomavirus(HR-HPV)were enrolled,and divided into low-grade squamous intraepithelial lesion(LSIL)group(n=20),high-grade squamous intraepithelial lesion(HSIL)group(n=56)and early cervical cancer group(n=60).A total of 25 HPV-negative subjects were defined as a control group.The T cell subsets in peripheral blood and vaginal lavage fluid were detected.Results:The peripheral blood CD3+and CD4+levels decreased with the aggravation of cervical lesions(P<0.05),but there were no significant differences in CD8+level and CD4+/CD8+ratio among the four groups(P>0.05).Compared with the control group,the CD4+level in vaginal lavage fluid and the CD4+/CD8+ratio were decreased in LSIL group,HSIL group and early cervical cancer group(P<0.05),while no significant difference was found in CD8+level among groups(P>0.05).Conclusion:The detection of T cell subsets is of great significance for the monitoring of SIL and early cervical cancer and the immunotherapy of cervical cancer.