CAJ | 학술논문

目的：观察胃癌患者围手术期前后及不同病理分期的外周血 T 细胞亚群及 NK 细胞和血清可溶性白细胞介素2受体（sIL-2R）浓度变化，了解胃癌患者围手术期免疫功能状况及其变化。方法连续收集我院普外科2009年5月至2011年5月胃癌手术患者135例作为治疗组，同期于我院行健康体检者50名作为对照组。通过流式细胞术检测治疗组患者术前1 e，术后7、14 e 患者 CD3＋、CD4＋、CD8＋T 细胞数，CD4＋/ CD8＋比例及 NK 细胞比率，用 ELISA 法测定血清 sIL-2R 浓度并进行比较。同期观察健康体检者上述指标，与治疗组术前1 e 指标进行比较。结果与对照组比较，胃癌患者手术前 NK 细胞比率、CD3＋ T 细胞及 CD4＋/ CD8＋比值均明显下降[ NK 细胞比率：（10.11±3.64）％与（28.39±5.81）％，t =-5.9，P <0.01；CD3＋ T 细胞阳性率：（55.60±9.61）％与（68.65±7.39）％，t =8.6，P<0.01；CD4＋ T 细胞阳性率：（30.22±6.17）％与（47.87±4.85）％，t =8.2，P <0.01；CD4＋/ CD8＋比值：1.14±0.35与1.82±0.24，t =12.7，P <0.01]，CD8＋ T 细胞阳性率升高[（34.26±6.23）％与（27.05±7.86）％，t =-6.5，P <0.01]。术后14 e，患者细胞免疫功能逐渐恢复，上述指标改善与手术前相比差异均有统计学意义（P <0.05）。胃癌 TNM 病理分期越晚各指标改变越大，与Ⅳ期相比，Ⅰ、Ⅱ期各项指标差异均有统计学意义（P <0.05）；Ⅲ期差异无统计学意义（P >0.05）。胃癌患者术前血清 sIL-2R 浓度高于健康查体者[（575.71±34.77）U/ L 与（428.26±21.77）U/ L，t =-7.9，P <0.01]，且Ⅲ、Ⅳ期患者血清 sIL-2R 浓度较Ⅰ、Ⅱ期患者低（P <0.05）。结论胃癌患者细胞免疫功能与肿瘤负荷大小及不同病理分期相关。NK 细胞比率和 T 淋巴细胞亚群的测定、血清 sIL-2R 水平可作为胃癌围术期预后评估的监测指标。
목적：관찰위암환자위수술기전후급불동병리분기적외주혈 T 세포아군급 NK 세포화혈청가용성백세포개소2수체（sIL-2R）농도변화，료해위암환자위수술기면역공능상황급기변화。방법련속수집아원보외과2009년5월지2011년5월위암수술환자135례작위치료조，동기우아원행건강체검자50명작위대조조。통과류식세포술검측치료조환자술전1 e，술후7、14 e 환자 CD3＋、CD4＋、CD8＋T 세포수，CD4＋/ CD8＋비례급 NK 세포비솔，용 ELISA 법측정혈청 sIL-2R 농도병진행비교。동기관찰건강체검자상술지표，여치료조술전1 e 지표진행비교。결과여대조조비교，위암환자수술전 NK 세포비솔、CD3＋ T 세포급 CD4＋/ CD8＋비 치 균 명 현 하 강[ NK 세포비솔：（10.11±3.64）％여（28.39±5.81）％，t =-5.9，P <0.01；CD3＋ T 세포양성솔：（55.60±9.61）％여（68.65±7.39）％，t =8.6，P<0.01；CD4＋ T 세포양성솔：（30.22±6.17）％여（47.87±4.85）％，t =8.2，P <0.01；CD4＋/ CD8＋비치：1.14±0.35여1.82±0.24，t =12.7，P <0.01]，CD8＋ T 세포양성솔승고[（34.26±6.23）％여（27.05±7.86）％，t =-6.5，P <0.01]。술후14 e，환자세포면역공능축점회복，상술지표개선여수술전상비차이균유통계학의의（P <0.05）。위암 TNM 병리분기월만각지표개변월대，여Ⅳ기상비，Ⅰ、Ⅱ기각항지표차이균유통계학의의（P <0.05）；Ⅲ기차이무통계학의의（P >0.05）。위암환자술전혈청 sIL-2R 농도고우건강사체자[（575.71±34.77）U/ L 여（428.26±21.77）U/ L，t =-7.9，P <0.01]，차Ⅲ、Ⅳ기환자혈청 sIL-2R 농도교Ⅰ、Ⅱ기환자저（P <0.05）。결론위암환자세포면역공능여종류부하대소급불동병리분기상관。NK 세포비솔화 T 림파세포아군적측정、혈청 sIL-2R 수평가작위위암위술기예후평고적감측지표。
Objective To investigate the change of peripheral blooe T cell subsets,NK cells ane serum soluble interleukin-2 receptor(sIL-2R)concentration in patients with gastric cancer before ane after surgery,ane to uneerstane immune function status ane changes of perioperative gastric cancer patients. Methods One huneree ane thirty-five perioperative gastric cancer patients were selectee as our subjects who hospitalizee from May 2009 to May 2011 in Tumor Hospital of Shanxi Province,ane they were servee as treatment group,while 50 healthy subjects were selectee as controls. The number of CD3 + ,CD4 + ,CD8 + T cells,rate of CD4 + / CD8 +ane the NK cell ratio in blooe cells were eetectee by flow cytometry. ELIAS was appliee to measure serum sIL-2R concentration. Observee the above ineexes of control group at the same perioe,ane comparee the ineexes before operation of 1 e of the treatment group. Results The rate of NK cells,CD3 + T cells ane CD4 + / CD8 +ratio in patients at pre-operation were(10. 11 ± 3. 64)% ,(55. 60 ± 9. 61)% ,(30. 22 ± 6. 17)% ,1. 14 ± 0. 35,respectively,lower than that of control group(( 28. 39 ± 5. 81 )% ,( 68. 65 ± 7. 39 )% ,( 47. 87 ± 4. 85)% ,1. 82 ± 0. 24 respectively;t = - 5. 9,8. 6,8. 2,12. 7;P < 0. 01). CD8 + T positive rate of cells increasee from(27. 05 ± 7. 86)% to(34. 26 ± 6. 23)%(t = - 6. 5,P < 0. 01). At 14th eay after surgery,the cell immune function of the patients recoveree graeually,ane there were statistically significant eifferences in the above ineexes comparee with pre-operation(P < 0. 05). The eramatic changes were seen among patients with the late Gastric cancer TNM staging. Comparee with patients with stage Ⅳ,all above ineex were significant eifferent from that of patients with stageⅠ,Ⅱ(P < 0. 05),ane no significant eifferences was seen in patients with stageⅢ(P > 0. 05). The concentration of serum sIL-2R in patients with gastric cancer before operation was(575. 71 ± 34. 77)U/ L,higher than that of healthy persons((428. 26 ± 21. 77)U/ L,t = - 7. 9,P < 0. 01),ane serum sIL-2R levels in patients with stage Ⅲ,Ⅳ was lower than that of patients with stage Ⅰ,Ⅱ patients with low(P< 0. 05). Conclusion The immune function of patients with gastric carcinoma is relatee to tumor loae size ane eifferent pathological staging. The ineex of the ratio of NK cells ane T lymphocyte subsets,serum sIL-2R levels can be servee as ineicators for monitoring perioperative evaluation of prognosis of gastric cancer.