西咪替丁对大肠癌患者免疫状态的调节作用

Study on the immune state of patients with colorectal cancer and immune regulation of cimetidine

目的:探讨大肠癌患者外周血T细胞亚群、可溶性的白介素2受体(sIL-2R)及肿瘤坏死因子(TNF)改变的规律及西咪替丁的免疫调节作用。方法:将40例大肠癌患者、30名正常献血者(对照组)为研究对象,40例患者随机分为西咪替丁组(n=20)和单纯手术组(n=20),西咪替丁组自术日开始每d静脉注射西咪替丁800 mg,1周后改为400 mg,3次/d,口服。应用碱性磷酸酶-抗碱性磷酸酶法(APAAP)及酶联免疫ELISA法,检测其术前、术后7 d、14 d、21 d时T淋巴细胞亚群、血浆sIL-2R及TNF,并进行组间比较。结果:①大肠癌组术前CD3+、CD4+及CD3+/CD8+ (57±5)％、(34±4)％、1.0±0.3)明显低于对照组((63±5)％、(40±3)％、1.4±0.2,P<0.01);CD8+、sIL-2R及TNF((33±4)％、(616±124)mg·L-1、(242±46)ng·L-1)明显高于对照组((28±3)％、(262±65)mg·L-1 、(91±8)ng·L-1,P<0.01)。②手术可进一步加重CD3+、CD4+及CD4+/CD8+的降低,使CD8+进一步升高,但这种变化是可逆的;而sIL-2R及TNF的降低,则是不可逆的。③应用西咪替丁可加速T细胞亚群、sIL-2R及TNF的显著改善。结论:大肠癌患者存在免疫功能低下,手术后免疫功能呈暂时抑制到逐渐恢复的过程;西咪替丁可增强患者的免疫功能,可作为结直肠癌患者的辅助治疗。

Aim : To study the clinical changes of sIL-2R, TNF, and lymphocyte subsets in peripheral blood for patients with colorectal cancer and the immunoregulation of cimetidine. Methods: A total of 40 patients were randomly allocated into two groups (cimetidine group, n =20,and control group, n =20) ,and 30 healthy subjects served as normal control. In cimetidine group, cimetidine was injected intravenously with a dose of 800 mg once per day for one week postoperatively, then 400 mg 3 times per day,orally. Blood samples were taken from peripheral vein before operation, and 7,14,and 21 days after operation. T lymphocyte subsets, serum sIL-2R,and TNF were detected by APAAP and ELISA. Results: The number of CD3+ and CD4+ positive cells and CD4 + /CD8+ rate were(57 ±5)% ,(34±4)% ,and (1.0±0.3) respectively in patients with colorectal cancer which were significantly lower than those in control group ( (63±5)% ,(40±3)% , and (1.4±0.2) ,P<0.01) ; the number of CD8+ positive cells and the level of sIL-2R and TNF((33± 4) % , (616 ± 124) mg · L-1 , (242 ±46) ng · L-1 ) were significantly higher than those in control group ((28±3)%,( 262 ± 65 ) mg · L-1 , and ( 91 ±8)ng · L-1 ,P <0.01). The operation may aggravate the drop of the number of CD3+ and CD4+ positive cells and CD4+/CD8+ rate,and the raise of the content of CD8+ ,and these changes were convertible, but the drop of sIL-2R and TNF level were unconvertible. Cimetidine may accelerate the improvement of T lymphocyte subsets,sIL-2R,and TNF. Con-Clusion : There is limited immune function in the patients with colorectal cancer. Surgical trauma can aggravate the immune balance of the patients with colorectal cancer. Cimetidine may enhance the immune function of patients, and could be used as an adjunct in the treatment of colorectal cancer.