肺癌患者手术前后细胞免疫功能的动态研究

Research on cellular immune function of patients with lung cancer before and after operation

目的 探讨原发性肺癌患者手术前后外周血T细胞亚群和NK细胞的动态变化规律 ,并分析相关的因素。方法 应用免疫荧光法检测 60例肺癌患者、15例肺良性肿瘤患者和 15例正常健康者外周静脉血T细胞亚群和NK细胞活性 ;肺癌组还进行了术后第 2、7、14和 2 8天外周血T细胞亚群和NK细胞的活性测定。结果 1.除CD8+ 外 ,肺癌组术前各项检测指标与肺良性肿瘤组和正常组比较有显著性差异 (P <0 .0 5 )。 2 .肺癌组术后第 2天 ,CD3 + 、CD4+ 、CD4+ /CD8+ 和NK细胞较术前显著性降低 ,而CD8+ 显著性升高 (P<0 .0 1) ;术后第 7～ 14天 ,各项指标基本上恢复到术前水平 (P >0 .0 5 ) ;术后第 2 8天 ,CD3 + 、CD4+ 、CD4+ /CD8+ 和NK细胞均较术前显著性增加 ,而CD8+ 显著性减少 (P <0 .0 5 )。 3 .术前ⅢA期和ⅢB期与ⅠB期比较 ,术前淋巴结转移N2 组与N0 组比较 ,各项指标均有显著性差异 (P <0 .0 5 ) ;术后第 2 8天根治性切除组和姑息性切除组与剖胸探查组比较有显著性差异 (P <0 .0 5 ) ;术后第 14天输血组与未输血组相比较 ,T细胞亚群有显著性差异 (P <0 .0 5 )。结论 肺癌患者的细胞免疫功能低于肺良性肿瘤患者和正常人 ;肺癌患者术后的免疫状态呈现先降后升的变化 ;TNM分期和淋巴结转移与术前细胞免疫功能有相关?

Objective To explore the perioperative changes of T subsets and NK cell and analyze the related factors in patients with lung cancer. Methods The T subsets and NK cell from peripheral blood of 60 patients with lung cancer, 15 patients with lung benign tumor and 15 healthy people were detected by immunofluorescence. These indexes of the patients with lung cancer were detected also at postoperative 2nd, 7th, 14th and 28th days. Results 1.There were significant differences in the indexes between the lung cancer group and the groups of lung benign tumor and normal people except for CD 8 +(P<0.05). 2.At postoperative 2nd day CD 3 +, CD 4 +, CD 4 +/CD 8 + and NK cell of the patients with lung cancer were decreased and CD 8 + was increased significantly than those before operation (P<0.05). During postoperative 1 to 2 weeks, all indexes had recovered basically to the preoperative level. At postoperative 28th day, CD 3 +, CD 4 + , CD 4 +/CD 8 + and NK cell were increased and CD 8 + was decreased than those before operation (P<0.05). 3. There was significant difference in the indexes among preoperative stage ⅢA, ⅢB and ⅠB, and between preoperative N2 diseases and N0 group (P<0.05). There was significant difference between the groups of radical and palliative operation and the group of thoracic exploration at postoperative 28th day (P<0.05). There was significant difference in T subsets between the groups of blood transfusion and non transfusion at postoperative 14th day (P<0.05). Conclusion The cellular immune function of the patients with lung cancer was lower than that of the patients with lung benign tumor and normal people. The perioperative immunity of patients with lung cancer decreases after operation and increases later. TNM stage and lymph node metastasis are relative to preoperative but not postoperative immunity. There is no significant correlation between cellular immune function and pathological type of the tumor. Radical and palliative operations can both significantly increase the patients' cellular immune function. Therefore the palliative operation is better than thoracic exploration. Blood transfusion can depress the immune function of the patients, so it is better to avoid perioperative blood transfusion.