192例恶性肿瘤患者应用重组人肿瘤坏死因子-α免疫功能与疗效的相关性分析

Evaluation on Application of Recombinant Tumour Necrosis Factor Alpha in 192 Patients with Malignant Neoplasms

观察重组人肿瘤坏死因子-α(rh-TNFα)静脉输注对恶性肿瘤患者细胞免疫功能的增强作用及影响因素,并分析其与rh-TNFα抗肿瘤作用的相关性。方法:选择具有明确病理诊断的复治或拒绝放、化疗的乳腺癌、恶性淋巴瘤、肾癌和恶性黑色素瘤患者,静脉输注rh-TNFα,100万U/m2,每日1次,每周连续5日,连用4周为1个疗程。采用免疫荧光直标染色法染色,以流式细胞仪检测治疗前后患者外周血T细胞亚群、NK细胞变化,同时评价抗肿瘤治疗的疗效。治疗前后细胞免疫功能比较采用配对t检验,免疫功能变化与抗肿瘤客观疗效的相关性采用多因素Logistic回归分析。结果:rh-TNFα给药后可提高患者外周血NK细胞和T细胞亚群数量,但CD4/CD8比值变化不明显,NK细胞和T细胞亚群的变化与rh-TNFα的抗肿瘤客观疗效的相关性不显著。结论:rh-TNFα具有一定的改善肿瘤患者细胞免疫功能的作用,但这种免疫增强作用可能不是其抗肿瘤疗效的最主要机制。

Objective:To evalute the immunological function enhancement of recombinant tumour necrosis factor alpha(rh-TNFα)in patients with advanced malignant tumor,and to analy-sis the influence factors of this immune regulation and the anti-tumour response of rh-TNFα-treatment.Methods:192patients with advanced breast cancer,malignant lymphoma,renal carci-noma and malignant melanoma were observed.TNFαwas administered at a dose of1×10 6 IU/m 2 ·d for5days a week,and a four weeks’continuous administration was one cycle.Immumofluores-cence method and flow cytometer(FCM)were applied to detect the changes of T lymphocyte sub-types and natural killer cell.At the end of the therapy cycle,the anti-tumour effects were evalu-ated.Paired t test was used to compare the difference in cellular immunity indexes between pretherapy and posttherapy.Multinomial logistic regression was adopted to analysis the correlation between the changes of cellular immunity indexes and anti-tumour response caused by TNFαinfu-sion.Results:After rh-TNFαadministration,the numbers of T cell subtypes and NK cell in pe-ripheral blood were significant incerased(p<0.05)otherwise these promotions had no close correla-tion to the anti-tumor response of TNFα(p>0.05).In addition CD 4 /CD 8 ratio had no marked change.Conclusion:rh-TNFαcould enhance the cellular immunity function.However,this kind of enhancement maybe not the principal mechanisms of rh-TNFαas antineoplastic agent.