CAJ | 학술논문

目的探讨高强度聚焦超声(HIFU)治疗对胰腺癌的免疫效应及HIFU疗效评估的影像学方法.方法以32例接受HIFU治疗的胰腺癌患者为研究对象.予癌细胞冷冻和复温处理制备冻融抗原.用HIFU破碎癌细胞制备HIFU抗原.用乳酸脱氢酶试剂盒检测无抗原致敏树突状细胞(DC)诱导的T淋巴细胞(DC-T)、冻融抗原致敏DC诱导的T淋巴细胞(冻融抗原-DC-T)、HIFU抗原致敏DC诱导的T淋巴细胞(HIFU抗原-DC-T)对自体胰腺癌细胞的杀伤作用.用ELISA法检测HIFU治疗前后患者免疫指标(热休克蛋白70、Th1/Th2、转化生长因子-β)水平的变化.比较HIFU治疗前后患者临床疗效指标[疼痛视觉模拟评分(VAS)、体力状况(PS)评分、CA19-9含量]的变化.分别用超声造影(CEUS)和CT评估HIFU治疗的即时疗效和近期(2个月)疗效.组间比较行q检验,治疗前后比较行t检验.结果与冻融抗原DC-T相比,HIFU抗原-DC-T对自身胰腺癌细胞的杀伤率更高(40.24％±10.56％比46.93％±13.26％,q=3.44,P＜0.05).与治疗前相比,HIFU治疗后患者的热休克蛋白70水平[(17.31±4.75) ng/ml比(22.84±5.58) ng/ml]、Th1/Th2(1.24±0.36比1.47±0.31)、转化生长因子-β水平[(1.39±0.41) ng/ml比(1.04±0.38) ng/ml]、VAS(3.97±1.32比3.26±1.18)、PS评分(2.76±1.02比2.21±0.86)、CA19-9含量[(135.39±37.45) U/ml比(114.82±30.51) U/ml]均获改善(t=4.278、2.739、3.542、2.268、2.332、2.409,P均＜0.05).CEUS和CT均显示HIFU治疗后肿瘤病灶血供减少,体积缩小.结论 HIFU能有效治疗胰腺癌,改善患者免疫状态,增强抗肿瘤应答.CEUS可实时评估HIFU疗效.
목적 탐토고강도취초초성(HIFU)치료대이선암적면역효응급HIFU료효평고적영상학방법.방법 이32례접수HIFU치료적이선암환자위연구대상.여암세포냉동화복온처리제비동융항원.용HIFU파쇄암세포제비HIFU항원.용유산탈경매시제합검측무항원치민수돌상세포(DC)유도적T림파세포(DC-T)、동융항원치민DC유도적T림파세포(동융항원-DC-T)、HIFU항원치민DC유도적T림파세포(HIFU항원-DC-T)대자체이선암세포적살상작용.용ELISA법검측HIFU치료전후환자면역지표(열휴극단백70、Th1/Th2、전화생장인자-β)수평적변화.비교HIFU치료전후환자림상료효지표[동통시각모의평분(VAS)、체력상황(PS)평분、CA19-9함량]적변화.분별용초성조영(CEUS)화CT평고HIFU치료적즉시료효화근기(2개월)료효.조간비교행q검험,치료전후비교행t검험.결과 여동융항원DC-T상비,HIFU항원-DC-T대자신이선암세포적살상솔경고(40.24％±10.56％비46.93％±13.26％,q=3.44,P＜0.05).여치료전상비,HIFU치료후환자적열휴극단백70수평[(17.31±4.75) ng/ml비(22.84±5.58) ng/ml]、Th1/Th2(1.24±0.36비1.47±0.31)、전화생장인자-β수평[(1.39±0.41) ng/ml비(1.04±0.38) ng/ml]、VAS(3.97±1.32비3.26±1.18)、PS평분(2.76±1.02비2.21±0.86)、CA19-9함량[(135.39±37.45) U/ml비(114.82±30.51) U/ml]균획개선(t=4.278、2.739、3.542、2.268、2.332、2.409,P균＜0.05).CEUS화CT균현시HIFU치료후종류병조혈공감소,체적축소.결론 HIFU능유효치료이선암,개선환자면역상태,증강항종류응답.CEUS가실시평고HIFU료효.
Objective To explore the immune effects of high intensity focused ultrasound (HIFU) in the treatment of pancreatic carcinoma and to investigate the imaging methods to evaluate HIFU's efficacy.Methods A total of 32 patients with pancreatic carcinoma treated by HIFU were enrolled.The freeze-thaw antigen was prepared by freezing and thawing the cancer cells.HIFU antigen was prepared by cancer cells sonicated by HIFU.The killing effects of no antigen activated dendritic cells (DC) induced T lymphocyte (DC-T),freeze-thaw antigen activated DC induced T lymphocyte (freeze-thaw antigen-DC-T) and HIFU activated DC induced T lymphocyte (HIFUantigen-DC-T) in autologous pancreatic cancer cells were detected by lactic dehydrogenase kit.The changes of immune indexes [heat shock protein 70 (HSP70),T helper lymphocyte Thl/Th2 and transforming growth factor-β (TGF-β)] before and after H IFU treatment were determined by enzymelinked immunosorbnent assay (ELISA) method.The changes of clinical efficacy indexes [visual analogue scale (VAS),performance status (PS) and carbohydrate antigen (CA) 19-9] before and after HIFU treatment were compared.The instant and recent (two months) efficacy of HIFU treatment were evaluated by contrast enhanced ultrasonograph (CEUS) and computed tomography (CT).The line q test was performed for comparision between groups.t-test was applied for comparision before and after treatment.Results Compared with freeze-thaw antigen,the killing effect of HIFU antigen-DC-T in autologous pancreatic cancer cells was higher (40.24％ ± 10.56％ vs 46.93％±13.26％,q=3.44,P＜0.05).HSP70 [(17.31±4.75) ng/mlvs (22.84±5.56) ng/ml],Th1/Th2 (1.24±0.36 vs 1.47±0.31),TGF-β [(1.39±0.41) ng/ml vs (1.04±0.38) ng/ml],VAS (3.97±1.32 vs 3.26±1.18),PS (2.76± 1.02 vs 2.21±0.86) and CA19-9 level[(135.39±37.45) U/ml vs (114.82±30.51) U/ml] improved after HIFU treatment compared with those before treatment (t=4.278,2.739,3.542,2.268,2.332 and 2.409,allP＜0.05).CEUS and CT showed that blood supply and the volume of the tumors reduced after HIFU treatment.Conclusions HIFU is effective in treating pancreatic carcinoma,improving immune status of patients and enhancing antitumor response.CEUS can real-time evaluate the efficacy of HIFU treatment.