CAJ | 학술논문

目的：探讨NKG2D配体MHC-I类相关分子A（MHC class I-related molecules A，MICA）在中晚期食管癌患者术后化疗联合NK细胞免疫治疗中的作用。方法：福建省肿瘤医院90例中晚期食管癌患者手术后，分为单纯化疗组40例、化疗联合NK细胞治疗MCIA阴性组（简称MICA-组）25例及化疗联合NK细胞治疗MICA阳性组（简称MICA+组）25例，比较其疗效。结果：与单纯化疗组及MICA-组相比，MICA+组CD3+、CD4+T细胞阳性率、NK细胞阳性率及CD4+/CD8+比率明显高于治疗前[（64.2±6.4）%vs （51.3±5.6）%，（39.8±8.2）% vs（29.5±3.2）%，（25.3±2.1）%vs（16.4±4.3）%，（1.4±0.5）vs（1.1±0.7）；均P<0.05]，T-reg细胞明显低于治疗前[（6.3±4.5）%vs（17.3±2.4）%，P<0.05]。3组疾病控制率及有效率无明显差异（P>0.05）。MICA+组KPS评分治疗后明显提高，MICA+组能明显改善化疗引起的白细胞减少、外周神经毒性症状，MICA+组疾病进展时间（time to progression，TTP）及总体生存时间（overall survival，OS）均明显延长（均P<0.05）。但单纯化疗组及MICA-组之间差异无统计学意义（P>0.05）。结论：食管癌组织MICA表达阳性的中晚期患者进行化疗联合自体NK细胞能有效能有效提高免疫力，改善患者生活质量，并能延长生存期，且回输安全、不良反应小。
목적：탐토NKG2D배체MHC-I류상관분자A（MHC class I-related molecules A，MICA）재중만기식관암환자술후화료연합NK세포면역치료중적작용。방법：복건성종류의원90례중만기식관암환자수술후，분위단순화료조40례、화료연합NK세포치료MCIA음성조（간칭MICA-조）25례급화료연합NK세포치료MICA양성조（간칭MICA+조）25례，비교기료효。결과：여단순화료조급MICA-조상비，MICA+조CD3+、CD4+T세포양성솔、NK세포양성솔급CD4+/CD8+비솔명현고우치료전[（64.2±6.4）%vs （51.3±5.6）%，（39.8±8.2）% vs（29.5±3.2）%，（25.3±2.1）%vs（16.4±4.3）%，（1.4±0.5）vs（1.1±0.7）；균P<0.05]，T-reg세포명현저우치료전[（6.3±4.5）%vs（17.3±2.4）%，P<0.05]。3조질병공제솔급유효솔무명현차이（P>0.05）。MICA+조KPS평분치료후명현제고，MICA+조능명현개선화료인기적백세포감소、외주신경독성증상，MICA+조질병진전시간（time to progression，TTP）급총체생존시간（overall survival，OS）균명현연장（균P<0.05）。단단순화료조급MICA-조지간차이무통계학의의（P>0.05）。결론：식관암조직MICA표체양성적중만기환자진행화료연합자체NK세포능유효능유효제고면역력，개선환자생활질량，병능연장생존기，차회수안전、불량반응소。
Objective:To explore the role of NKG2D ligand MHC-I related molecule A (MICA) in chemotherapy combined with NK cell immunotherapy in patients with advanced esophageal cancer after surgery. Methods:A total of 90 patients with esophageal cancer from Fujian Provincial Tumor Hospital were divided into three groups after surgery:40 patients of chemotherapy alone, 25 patients of chemotherapy combined with NK cell therapy with negative expression of MICA (MICA-group), and 25 patients of chemotherapy combined with NK cells therapy with positive expression of MICA (MICA+group). The efficacy was then compared. Results:Compared with the chemotherapy alone and MICA-groups, the positive rates of CD3+, CD4+T cells, NK cells, and the CD4+/CD8+ratio in peripheral blood from MICA+group were higher than those before treatment (64.2%± 6.4%vs. 51.3%± 5.6%, 39.8%± 8.2%vs. 29.5%± 3.2%, 25.3%± 2.1%vs. 16.4%±4.3%, 1.4%± 0.5%vs. 1.1%± 0.7%;P<0.05). Meanwhile, the levels of T-reg cells were lower than those before treatment (6.3%± 4.5%vs. 17.3%± 2.4%, P<0.05). No significant difference was observed between the disease control rate and response rate. Chemotherapy-induced neutropenia and peripheral neurotoxicity symptoms were significantly improved, and time to progression (TTP) and overall survival (OS) were significantly prolonged (P<0.05). No statistically significant difference was observed between the chemotherapy alone group and MICA-group (P>0.05). Conclusion:Treatment with chemotherapy and autologous NK cells on patients with advanced esophageal carcinoma and MICA positive expression can be safely transfused with only minor side effects and can effectively improve a patient's immune system, quality of life, and survival.